Australian Nursing & Midwifery Journal Volume 21, No. 11. June 2014
Women leading the way www.anmf.org.au
WE’VE BEATEN THE BIG 4 ON HOME LOANS. EVERY YEAR SINCE 2001. ME BANK
If you had a standard variable home loan with ANZ, CommBank, Westpac or NAB, you could have paid up ^ to $23,579 extra in over the last 10ME years. ME BANK MEinterest BANK BANK Call ME BankMEtoday BANK and find out how you could save with our SMHL standard variable home loan. ANZ
Standard Variable Rate Home Loan customers paid up to an additional
Variable Rate Home Loan customers paid up to an additional
Rocket Repay Home Loan customers paid up to an additional
Tailored Variable Rate Home Loan customers paid up to an additional
BOOK AN APPOINTMENT TODAY. WE’LL COME TO YOU. CALL 1300 654 995 OR VISIT MEBANK.COM.AU/HOMELOANS. ^Super Members Home Loan (SMHL) Standard Variable Home Loan is available to eligible super fund and union members. A list of eligible super funds and unions can be found at mebank.com.au Data: InfoChoice. Savings calculated on a 30 year, $300,000 principal and interest home loan after 10 years (01/02/04 – 01/02/14) on the ME Bank SMHL Standard Variable Rate versus the standard variable home loan rates of ANZ, CBA, NAB and Westpac. Assumes the same monthly repayment is made to each loan, based on the minimum repayment of the loan with the higher interest rate. Interest calculated daily and applied monthly. Calculations do not include applicable fees, charges or discounts and do not consider other home loan products from these lenders that may carry different interest rates. Terms, conditions, fees and charges apply. Applications are subject to credit approval. Members Equity Bank Pty Ltd ABN 56 070 887 679 Australian Credit Licence 229500. 213584/0514
Australian Nursing & Midwifery Journal - www.anmf.org.au
Editorial Lee Thomas, Federal Secretary The heart out of health care has most certainly been ripped out, torn and shredded after last month’s crushing federal budget announcement. Like a wild tornado the budget single handedly devastated and destroyed not only health care, but social services and education as we know it today, leaving the sick, poor, elderly and young without the support that they crucially need to survive. Breaking his election promise, Prime Minister Abbott has introduced co-payments to visit bulk billing GPs. Adding insult to injury he has increased the price of prescription medicines, prescription medicines, pathology and radiology as well. If you believe the government rhetoric, the extra fees put on patients will help sustain our health care system. But clearly this is extremely short sighted and is destined to fail as costs will increase as health outcomes worsen. Slashing $15 billion to yearly hospital funding only adds fuel to this fire. Massive pressures will be placed on hospitals, states and territories, potentially resulting in severe cuts to hospital and health services.
congratulate the many winners of this year’s nurse and midwife of the year awards. Each year these awards are held in each state and territory and also nationally to coincide with International Nurses’ and Midwives’ celebrations. This year the enthusiasm and innovation among the professions was evident. The candidates, along with many of you, are clearly passionate about achieving the best possible outcomes for patients, and because of your drive makes me proud to stand among you and do the best I can do for the professions. National nurse of the year, Victorian mental health nurse Steve Brown’s story is on page six. Coincidently, our Focus section is on mental health. This month we were inundated with contributions, which should make for interesting reading, discussion and debate. I also urge you to read the industrial column which discusses the issues around employing overseas nurses and midwives at a time when many new nursing and midwifery graduates find it difficult to secure employment. The column also details the ANMF’s submission to the government on the situation.
While a bleak and unstable future may seem inevitable for nurses, midwives and other health care workers, not to mention young and old Australians, families, the sick and the vulnerable, the ANMF is determined now more than ever to fight for Medicare and the health of our nation. I urge you all to get involved and fight for what we have worked so hard for. Together in numbers, unity and strength our voice will be heard. Flick through the pages of this month’s ANMJ to read a wrap up of the budget and what it means for you. On a brighter and more positive note I would like to take this opportunity to PAGE 1 June 2014 Volume 21, No. 11.
ANMF Directory Australian Nursing & Midwifery Federation National Office www.anmf.org.au Canberra
3/28 Eyre Street, Kingston ACT 2604 Phone (02) 6232 6533 Fax (02) 6232 6610 Email firstname.lastname@example.org
Melbourne & ANMJ
Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email email@example.com
Front Cover Federal Secretary Lee Thomas
Assistant Federal Secretary Annie Butler
Photography by Dan Murphy
Editor: Kathryn Anderson Journalist: Kara Douglas Production Manager: Cathy Fasciale Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email firstname.lastname@example.org
The Media Company, Jana Gungor Phone (02) 9909 5800 Fax (02) 9909 5810 Email email@example.com
Australian Capital Territory
Branch Secretary Jenny Miragaya Office address Unit 3, 36 Botany Street, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: firstname.lastname@example.org
Branch Secretary Yvonne Falckh Office address 16 Caryota Court, Coconut Grove NT 0810 Postal address PO Box 42533, Casuarina NT 0810 Ph: (08) 8920 0700 Fax: (08) 8985 5930 E: email@example.com
Branch Secretary Elizabeth Dabars Office address 191 Torrens Road, Ridleyton SA 5008 Postal address PO Box 861 Regency Park BC SA 5942 Ph: (08) 8334 1900 Fax: (08) 8334 1901 E: firstname.lastname@example.org
Branch Secretary Lisa Fitzpatrick Office address ANMF House, 540 Elizabeth Street, Melbourne Vic 3000 Postal address Box 12600 A’Beckett Street PO Melbourne Vic 8006 Ph: (03) 9275 9333 Fax (03) 9275 9344 Information hotline 1800 133 353 (toll free) E: email@example.com
Design and production Design: Origin of Image (OoI) Pty Ltd Printing: AIW Printing Distribution: D&D Mailing Services
The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrangement with the Australian Nursing & Midwifery Federation Federal Office Note: anmj is indexed in the cumulative index to nursing and allied health literature and the international nurSing index ISSN 2202-7114
New South Wales
Branch Secretary Brett Holmes Office address 50 O’Dea Avenue, Waterloo NSW 2017 Ph: 1300 367 962 Fax: (02) 9662 1414 E: firstname.lastname@example.org
Branch Secretary Beth Mohle Office address 106 Victoria Street West End Qld 4101 Postal address GPO Box 1289 Brisbane Qld 4001 Phone (07) 3840 1444 Fax (07) 3844 9387 E: email@example.com
Branch Secretary Neroli Ellis Office address 182 Macquarie Street Hobart Tas 7000 Ph: (03) 6223 6777 Fax: (03) 6224 0229 Direct information 1800 001 241 (toll free) E: firstname.lastname@example.org
Branch Secretary Mark Olson Office address 260 Pier Street, Perth WA 6000 Postal address PO Box 8240 Perth BC WA 6849 Ph: (08) 6218 9444 Fax: (08) 9218 9455 1800 199 145 (toll free) E: email@example.com
Moving state? Transfer Your anMf membership If you are a financial member of the ANMF, QNU or NSWNMA, you can transfer your membership by phoning your union branch. Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.
Source: BCA verified audit, March 2014
Contents Volume 21, No. 11. News 5 World 13 Women leading the way
Industrial 17 Feature 18
Women leading the way 14
Reflections 24 Ethics 33 Clinical Update
Fight looming over health budget cuts
Research 37 Focus 38 Books 53 Calendar 54 Mail 55 Sally 56
Learning from clinical leaders
Feature: The responsibility of care
A conversation about the Registered nurseâ€™s role.
PAGE 3 June 2014 Volume 21, No. 11.
Bendigo Nurses’ Conference
of CPD rs
About the conference
This program enhances nurses’ awareness of current best-practice relating to a range of clinical topics. It aims to fill knowledge gaps in certain general as well as specialist areas of care and in so doing provide nurses with insights that will be immediately relevant to their practice.
A Breath of Air: Respiratory Medication Management Communicating Unmet Needs, or Behavioural Challenges? Dealing with Difficult Behaviours in the Workplace llicit Drugs: A Nursing Challenge Seizures Out In the Open
The program will be stimulating and interactive and debate will be encouraged.
A Spreading Concern - Chlamydial Infection
Register Today Date Venue QRC
Thu 7 and Fri 8 | Aug 2014 Lakeview Resort | 286 Napier St | Bendigo VIC 3550
To register for this conference, enter the QRC at: www.ausmed.com.au/course
www.ausmed.com.au Ph (03) 9326 8101
Ausmed Education Online Learning | Conferences | Publications
News Fight looming over health budget cuts
ANMF Assistant Federal Secretary Annie Butler interviewed by media after budget lock up
The Australian Nursing & Midwifery Federation (ANMF) will fight to defend Medicare and the health of all Australians against the savage cuts to the health care system in the federal budget. ANMF Federal Secretary Lee Thomas said a $7 co-payment for GP visits and higher costs for pathology, radiology and prescription medicines will have a devastating impact on Australia’s health care system and hit those who can least afford it the hardest. “Low income earners, the elderly and struggling families will be forced to put off seeking medical treatment until it’s too late.” Tony Abbott’s attack on Medicare is short sighted and will cost much more long term, said Ms Thomas. “Any short term savings will be outweighed by higher health and hospital costs as a consequence of people not going to the GP or taking prescribed medicines because they can’t afford it.” As frontline health professionals, nurses know people must seek treatment sooner rather than later, said Ms Thomas. “Otherwise those so-called minor ailments develop into serious, often chronic illnesses which go on to require expensive chronic care in hospitals.” Ms Thomas said Australians already pay for universal health care through tax, the Medicare levy and private health insurance for those who can afford it. “As Australia’s largest health union, the ANMF is deeply concerned at the Abbott government’s failure to consult with nurses and midwives or other health professionals on the best ways to sustain and improve the health system.” Consumer health groups also slammed the budget as full of pain for patients. “It shatters the notion of universal access to primary care under Medicare,” said Consumers Health Forum of Australia CEO Adam Stankevicius.
There are also concerns people living in rural and remote areas will be hit particularly hard by the increased patient contributions. “Out-of-pocket health care costs are already higher in rural and remote areas and many people make extraordinary efforts to access a GP, including paying transport costs. The last thing rural patients need is another barrier to accessing primary care,” said National Rural Health Alliance’s Chair Dr Tim Kelly. “Rather than slashing health spending and ending Medicare, Tony Abbott should be directing resources into preventative and primary care and controlling costs by preventing unnecessary procedures and readmissions,” said ANMF Federal Secretary Lee Thomas. The ANMF will fight to defend Medicare and is calling on members of the Senate to reject the Abbott government’s ruthless attack on health care in the budget. In order to do this Ms Thomas said the ANMF is planning an online campaign. “Watch out for this campaign on our website, www.anmf.org.au I urge each and every one of you to get involved so that we can protect and sustain our health care system as we know it.”
What the budget means for nurses and midwives: Health cuts While the Budget had some wins for nurses and midwives, such as $23.4 million for the Mental Health Nurse Incentive Program for 12 months, this was overshadowed by the dramatic cuts to the health care system which include: • $7 co-payment for visits to bulk billing GPs, pathology and diagnostic imaging services • $5 increase in PBS co-payments for general patients and $0.80 for concessional patients • Potential charge to attend public hospital emergency departments • Hospital funding agreements with the states and territories to be wound back from 2017, cutting $50 billion over eight years • Income thresholds for the Medicare levy surcharge and the private health insurance rebate will be frozen for three years • The Australian National Preventative Health Agency and Health Workforce Australia to be axed and absorbed into the Health Department • Medicare Locals to be replaced by a smaller number of bodies called Primary Health Networks, which will perform a similar function PAGE 5 June 2014 Volume 21, No. 11.
Nurses and midwives March in May Nurses and midwives were among thousands of Australians who took part in national March in May rallies to protest the Federal Government’s 2014 budget. Protesters expressed their anger over announced budget cuts, including health and education, at rallies in Adelaide, Brisbane, Melbourne, Sydney, Perth and Hobart on Sunday 18 May. Australian Nursing & Midwifery Federation (ANMF) Assistant Federal Secretary Annie Butler and NSW Nurses and Midwives’ Association (NSWNMA) General Secretary Brett Holmes joined nurses and midwives to protest at the rally in Sydney. Ms Butler said the savage cuts to Australia’s health care system will dangerously compromise the amount of safe care able to be provided to people across the community. “Tony Abbott’s attack on Medicare has ripped the heart out of the Australian health system. Australians didn’t vote for
ANMF Assistant Federal Secretary Annie Butler and NSWNMA General Secretary Brett Holmes with NSWNMA members
these devastating changes to our health system and ultimately it’s everyday Australians who will suffer.”
Ms Butler said the ANMF will fight to keep universal health care for all Australians.
Mental health nurse wins top national nursing award the number of people with mental illness being brought to the Northern Hospital’s emergency department (ED) by police. “It provides us the opportunity to have a police officer and a clinician as a separate unit to attend the scene and make a determination on whether the person does have a mental illness, does require treatment and how that treatment can occur, or to make appropriate re-referral,” said Steve.
A mental health nurse from Melbourne has been named Nurse of the Year at the HESTA Australian Nursing Awards.
It means there is no need for police to take a person with a mental illness to an ED. “If the person does require hospitalisation that can happen directly to a psychiatric inpatient unit,” Steve said.
Steve Brown said he was shocked to hear his name read out. “There were four other finalists standing up there and I had listened to what they’d achieved and I was feeling very honoured to be a selected finalist, so I was a bit taken aback to actually win.”
Since the introduction of PACER, there has been a significant decrease in mental health presentations to the Northern Hospital’s emergency department, which is one of the busiest in Melbourne.
Steve was recognised for his role in implementing the Police Ambulance Clinical Emergency Response (PACER) system, which has dramatically reduced PAGE 6
“Prior to PACER we were getting upwards of 100 presentations a month. Usually those people would be arriving in the back of a divisional van and usually the situation had already escalated to a point where the
person was highly agitated by the time they got to the emergency department, which then meant that there were a lot of resources required to try to contain that situation in the ED,” said Steve. The Nurse of the Year Award comes with $5,000 in prize money and a $5,000 education grant. Steve plans to use the money to either investigate better collaboration in mental health and emergency services or ways of managing aggression and violence in EDs. Other award winners include Outstanding Graduate of the Year Zoe Sabri (pictured left) from the Royal District Nursing Service in Melbourne, who was recognised for her work assisting elderly people to continue living safely in their home. Professor Jeanine Young (pictured right) also accepted the Team Innovation Award for the Apunipima Pepi-pod Program in Cape York, which helps reduce the rates of Sudden Unexpected Death in Infancy (SUDI) among Aboriginal and Torres Strait Islander communities.
News Depression risk for young mums Women who were teenagers or young adults when they had children have higher rates of depression or anxiety among mothers. Research from beyondblue shows about a third of women who were aged 14 -24 when they gave birth reported they had experienced depression or anxiety in the past 12 months. beyondblue CEO Georgie Harman said young mothers face higher risks of developing depression due to a range of reasons such as social isolation, financial pressures, relationship problems and family turmoil.
“These figures show young mums are at risk of experiencing depression and anxiety if they don’t get the help they need early.” Ms Harman said being a young mother can be particularly challenging and make adolescents more vulnerable to mental health problems, which can continue into adulthood. “We want all mothers to reach out if they feel overwhelmed, sad or overly anxious.” Young mums and their families should keep an eye on how they’re coping with their new parental responsibilities, said Ms Harman. “If they’re having difficulty adjusting, take action to get help before depression or anxiety becomes debilitating.”
The NSW Mental Health Association has launched a new online resource to address the issue and help young mums deal with difficult circumstances. The website, www.ivebeenthere.org.au, has advice for young parents on how to prepare for a baby, pregnancy and parenting challenges, emotional wellbeing and how to access support from friends, family and health professionals.
Decision hurts nurses and midwives NSW public sector nurses and midwives will lose out on a promised 2.5% salary boost due to a successful state government court battle to overturn the pay rise. Twelve months ago the Industrial Relations Commission awarded public sector employees including nurses, midwives and other health workers a 2.5% award increase, in addition to the federally legislated 0.25% increase in their superannuation entitlements. But a decision to exclude superannuation from the 2.5% salary increase was overturned in the Court of Appeal last month.
NSW Nurses and Midwives’ Association (NSWNMA) General Secretary Brett Holmes said it was a devastating outcome for public sector workers, including many NSWNMA members. “As a result the NSW government promised 2.5% wage policy now becomes a 2.27% wage policy.” Due to the decision Mr Holmes said the state government had taken the rights of public sector workers to bargain. “The ultimate impact from this is that it has allowed the Baird government to determine bargaining and wage outcomes for public sector workers. “Continued poor pay outcomes which fail to recognise increased productivity,
workloads and responsibility will return nurses and midwives to the bad old days of nurses and midwives leaving the profession to use their skills elsewhere.” NSW Treasurer Andrew Constance welcomed the Court of Appeal decision stating that it was a significant decision which avoided a $850 million hit to the NSW Budget and a potential loss of around 8,000 public sector jobs. “Our wages policy is completely consistent with the historical treatment of superannuation at both federal and state levels, and today’s Court of Appeal decision backs that position.”
Health care innovation A showcase of health care initiatives driven by nurses and midwives to improve health outcomes was held in Sydney last month. With over 500 nurses, midwives and other health professionals in attendance, the Essentials of Care (EOC) showcased different initiatives which aimed to enhance the experience and care of patients, families and carers by engaging health care teams and utilising evidence from patients and their families, workplace data and research. NSW Health Minister Jillian Skinner said EOC had been implemented across the state, with more than 700 teams currently engaging in the program. “Essentials of Care involves the whole team with an aim to promote positive workplace cultures in a way that aligns with the NSW Health’s
core values- collaboration, openness, respect and empowerment. “The initiatives implemented as part of the program have made improvements in areas such as patient safety, clinical handover, falls and pressure injury prevention, as well as medication management.” Ms Skinner said she was impressed at the showcase by the range of local EOC innovations that were being led by nurses at hospitals around the State. Some of the innovations included: • A process to significantly reduce the amount of skin harvested from a patient, resulting in less pain during recovery, devised by the staff at the Concord Hospital Burns Unit; • A sensory garden created by nursing staff at Cumberland Hospital’s mental health rehabilitation which resulted in significant
decreases in the number of aggressive incidents, staff injuries, episodes of seclusion and the use of restraint, as well as a 70% reduction in sick leave; • A common cardiac terms and information brochure to help patients and families better understand the complex language of cardiology, developed from a survey of patients at the Wyong Hospital Cardiac Care Unit. Ms Skinner said while upgrading infrastructure and boosting workforce numbers was important in achieving better patient outcomes, supporting the development of new care models was necessary too. “As demand on our health system grows, we must find innovative ways to deliver high quality, timely care to more people. Essentials of Care encourages innovation and local solutions to local problems.” PAGE 7 June 2014 Volume 21, No. 11.
LIMITED OFFER 2 FREE Gifts
Promotion Dates: May - July 2014
enurse.com.au/eshop QuickStudy Posters (Laminated) 50cmx66cm Muscular System
1300 886 814 Nursing Shoes
13 Pocket Nurse Pouch
View styles and availability online
RRP NOW $ 95 $
$ 15 ea
24hr Processing Flat Rate Postage
2 FREE Gift
gy er Clip Thin
Model Skeleton - Mini 42cm Stand and attitude included â˜ş
Two FREE gifts with every order placed! Plus you get automatic entry into the Cruise giveaway every time you spend $50 or more.
d Calc Card
Visit Online for Terms & Conditions
r two o f e is u r c win a
*Prices include GST |*While Stocks Last
zing Another ama ay! prize giveaw
News Needlestick injuries avoidable Sharp and needlestick injuries affect over 19,000 Australian health care workers each year, a figure that is not in decline, according to the Alliance for Sharps and Needlestick prevention in Health care.
In addition to the high rates of injury known, approximately 50% of needlestick injuries are not reported, a spokesperson for the Alliance said. “According to studies under reporting ranged from 40% to 80%. The main reasons for not reporting incidents includes being too busy to report, fear of being blamed, unsure who to report to and perceiving the risk from injury and therefore not necessary to report.” A needlestick or sharps injury could result in health care workers exposed to potentially life threatening blood borne diseases such as hepatitis B or C or HIV, causing great stress for health care workers and generating significant avoidable cost for the Australian health care system, according to the Alliance.
“Studies have shown the majority of NSIs are preventable through the implementation and use of safety engineered medical devices (SEMDs) combined with relevant education and training programs for health care workers,” the spokesperson said.
The Alliance, which includes peak nurse bodies such as the ANMF and the Australian College of Nursing has been calling on state and federal jurisdictions to mandate the use of SEMDs to avoid needlestick and sharp injuries. “Over the years individual health facilities in Australia have implemented SEMDs on a voluntary basis but there is no nationally consistent approach. Although there are a wide variety of SEMDs available to purchase via various state and territory purchasing contracts, the implementation and use of SEMD is not a mandatory requirement for health facilities. With no prescriptive legislation or policy in place to protect health care workers from the risk of occupational expo-
Images to breakdown stereotypes Photographs will be used in a study to aid nursing and medical students to see older people in a different light.
Researchers from the University of Western Australia (UWA) will lead the study which will entail portraying images of older people, from healthy men and women to a dependent state. The researchers hope portraying images to the nursing and medical students will promote classroom discussion around ageing and exploration around potential unexamined stereotypes or ageist perceptions they may hold towards older people.
The WA Nurses Memorial Centre Charitable Trust grant has funded the research to evaluate and explore the photographs as a teaching and learning tool for students. UWA lecturer and researcher, Assistant Professor Gabrielle Brand, said winning the grant allowed the researchers to make important inroads in developing teaching and learning tools that could better prepare future health professionals to function within complex and ever changing health systems. “This grant will fund essential research that will lead to new knowledge in developing visual tools that better prepares and enhances the quality of medical and nursing practice and education.”
Have your say: privately practising midwives The Nursing and Midwifery Board of Australia is investigating potential models of supervision for privately practising midwives (PPMs) and wants to hear their perspective on the issue. PricewaterhouseCoopers will run a series of focus groups for the Nursing and Midwifery Board in June and July. The discussion sessions will be held in Brisbane, Sydney, Melbourne, Adelaide and Perth, while participants from the ACT and Tasmania can attend sessions in Sydney, Melbourne or Adelaide. An online survey will also be available on the National Board’s website for those who are unable to attend a focus group. Contact Daniel Gilbertson at PricewaterhouseCoopers by 13 June to register for a focus group: firstname.lastname@example.org or (03) 8603 0323.
sure to bloodborne pathogens, needlestick and sharp injuries will continue to occur,” the spokesperson said. Last year a private members motion on sharps injuries was debated in Federal Parliament with bi-partisan support for SafeWork Australia members, including state and territory representatives to consider a review of existing work, health and safety guidance material on preventing sharps injuries including mandatory use of SEMDs in health care. However advocacy work remains ongoing according to the Alliance. “Active support from nurses, midwives and other health care workers is vital to ensure that needlestick injuries are no longer accepted as ‘part of the job’.”
Depression screening tool for remote communities A new screening tool for depression among older Aboriginal and Torres Strait Islander Peoples in remote areas has been developed by the University of Western Australia.
The tool, based on the commonly used risk assessment tool Patient Health Questionnaire (PHQ-9), is the first of its kind that is culturally acceptable. The University’s Professor Leon Flicker said the tool was adapted by re-wording and translating some of the questions to align with Indigenous cultural norms. “We then validated the instrument amongst remote living Indigenous communities.” Named Kimberly Indigenous Cognitive Assessment of Depression (KICA-dep) after the place it was developed, the tool was endorsed via a cross-sectional survey of adults from six remote communities in the Kimberley. The KICA-dep was a sub-project of the ‘Kimberley Healthy Ageing Project’. The study included 250 men and women aged 46-89 years. The tool is freely available on the Western Australian Centre for Healthy Ageing website: www.wacha.org.au/kica.html PAGE 9 June 2014 Volume 21, No. 11.
Celebrating nurses and midwives Nurses and midwives around Australia took time out to attend breakfasts, morning teas and other events to celebrate International Nurses’ Day and International Day of the Midwife last month. Australian Nursing & Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the international days recognise the crucial role nurses and midwives play in delivering quality care across the health system. “Nurses and midwives are the backbone of the health care system worldwide. It’s important to recognise the hard work they do and the vital role they play.” ested to know about International Nurses’ Day. “I had a balloon from the ANMF on the table and everyone took balloons back to the centre to blow up. People comment on balloons and then you’ve got the opportunity to fill them in on what it’s all about.”
Infant Mental Health
of CPD rs
Melbourne Nursing Conference
community but we also have a lot of laughs and fun. We work in isolation in little centres so when we come together there’s lots to talk about and it’s non-stop talk.” Carole said they also had a great reaction from members of the public who were inter-
ANMF (Victorian Branch) job rep Carole Ellis helped organise a breakfast for the Knox Maternal and Child Health Nurse team (pictured) in Melbourne to celebrate International Nurses’ Day 12 May. She said it was a great way to get the team together. “It’s a lot of fun. We work busy days serving the
About the conference
If an infant has a disordered attachment or is maltreated in the perinatal or infant period of their life the consequences can be long term and catastrophic.
Encouraging Attachment with Adolescent Mothers
This conference is to promote the fundamental importance of infant mental health to the wellbeing of humans across the lifespan. It is designed for any nurse, midwife or other professional who works with families of young babies aged 0-3 years.
When Birth is Traumatic
The Infant’s Experience of Family Violence
‘Where Am I Tonight?’ - Infants in Overnight Care
Mon 1 and Tue 2 | Sep 2014 Hotel IBIS Melbourne 15-21 Therry St, Melbourne VIC 3000
To register for this conference, enter the QRC at: www.ausmed.com.au/course
How Parental Mental Illness Affects Infants Working With The Baby: Tuning Into Needs
www.ausmed.com.au Ph (03) 9326 8101
Ausmed Education Online Learning | Conferences | Publications
News Cut salt to save lives Nurses have an important role to play in helping individuals cut their sodium intake, which is one of the main risk factors of cardiovascular disease (CVD) and hypertension.
That was one of the key messages for nurses at the World Heart Federation’s World Congress of Cardiology in Melbourne last month. “Sodium reduction is a very important role for nurses to take on and worldwide it’s a major contributor to CVD,” said conference speaker Nancy Houston Miller from the Preventative Cardiovascular Nurses Association in the United States.
Ms Houston Miller told the conference thousands of lives and millions of dollars could be saved if changes were made globally to reduce sodium intakes.
“This is a multi-faceted approach and the behaviours need to occur at the policy and environmental level in relation to reducing sodium within foods at a national level, which requires industry to support government initiatives, in addition to helping individuals at an individual level to determine their capability to read food labels and to make appropriate food choices when they are shopping.”
Globally, fewer than 1% of men and 2% of women consume less than the recommended daily sodium intake.
Ms Houston Miller said there were many social determinants of food choices, including social, biological, psycho-social and an individual’s knowledge and attitudes regarding food and as a result, regarding sodium.
In Australia, the recommended daily intake is four grams of salt a day (1500mg of sodium) which is equal to one teaspoon of salt. However, on average Australians consume between 6.5 -12 grams of salt a day, which is up to three times the recommended daily amount, delegates at the conference heard.
“It makes it very difficult [to change behaviour] because people make choices not only on taste and hunger but also such things as income, availability, culture with regard to what families choose to do and certainly their capability and knowledge around sodium items within the diet.”
Nancy Houston Miller
Ms Houston Miller said research showed nurses were very effective at introducing behavioural change and are a vital resource. “Nurses have a major role to play in helping individuals with individual change and this includes everything from helping them to know what are the goals on a daily basis for sodium to determining major items within an individual’s diet that contribute to sodium and then helping them make small, incremental, gradual changes within their diets, which relates to both setting goals and self-monitoring behaviours.”
Pap test could be scrapped ing technology, Australia is in a position to introduce an even more effective approach that is just as safe as the Pap test, said Professor Olver. “In its first 10 years, the Pap test based program reduced mortality by 50%, a figure that plateaued in the subsequent decade. The HPV test is predicted to further reduce mortality by 15%.”
A new five yearly test for HPV (human papilloma virus) could soon replace the Pap test. The Australian Medical Services Advisory Committee has recommended the new HPV test become the primary cervical screening tool in Australia. The Cancer Council has welcomed the recommendations and said evidence showed the new test would be more effective than the Pap test and just as safe.
The government is still considering the recommendation and it is likely the changes would not be implemented before 2016. Cancer Council CEO Professor Ian Olver said it is important women continue to have Pap tests every two years for now. “The Pap test based screening program has been a great public health success story since its introduction in 1991 and is the main reason cervical cancer rates in Australia are among the world’s lowest.” However, with the introduction of the HPV vaccine in 2007 and enhancements in test-
The key recommendations for the new HPV test are: • an HPV test should be undertaken every five years; • cervical screening should commence at 25 years of age; • women should have an exit test between 70 and 74 years of age; • women with symptoms (including pain or bleeding) have a cervical test at any age. Professor Olver said the changes should also include improved targeting of the program to Indigenous women, who have not shared equitably in Australia’s cervical cancer successes. “If the changes are adopted, as recommended, we will be urging Australian women of all backgrounds to embrace the new approach to screening from 2016 so we can continue to improve on Australia’s record in the early detection and treatment of cervical cancer.” PAGE 11 June 2014 Volume 21, No. 11.
News Aussie kids not getting enough exercise Dr Schranz said children are not spending as much time outdoors because of television and computers. “Things like walking to school, playing outside and turning off televisions and computers contribute to overall health and physical activity levels – and these things are being forgotten.”
Professor Shilton said it requires a coordinated response with governments, communities, schools, families and individuals all playing a role. “We know what works. We need high quality, mandatory physical
activity in our schools. We need to encourage and support our kids to stay active in everyday life – to be social and play outside, to walk and cycle in their neighbourhoods, do some household chores and limit hours of screen time.” The full report card is available at www. activehealthykidsaustralia.com.au.
Night Duty Nursing
of CPD rs
Associate Professor Trevor Shilton from the Heart Foundation said the evidence can’t be ignored. “We’re raising a generation of couch potatoes and we don’t start to reverse this trend this will drive up health problems in the future – obesity, high blood pressure and heart disease.”
The inaugural Active Healthy Kids Australia report card found 80% of children between the ages of five and 17 are not getting the recommended minimum 60 minutes of exercise a day. The report card was compiled by researchers from Australian universities and endorsed by the Heart Foundation. It ranks the physical activity of Australian children against 14 other nations. Report author Natasha Schranz from the University of South Australia said too many Australian parents think playing sport is enough to keep their kids healthy. “Australia is a sporting nation and vast numbers of children are involved in some type of organised sport but this report clearly shows we need to be looking at further ways to keep kids active when they are not on the sports field.”
The report shows 80 per cent of Australian children aged between 12 and 17 look at screens more than the recommended limit of two hours per day.
Adelaide Nursing Conference
Australian school children rank among the worst in the world for overall physical activity levels, according to a new report.
About the conference
Nurses who work at night are exposed to different environmental conditions than those on day shifts. This includes reduced or delayed availability of professional resources (including staff); increased risk; untoward clinical problems, and patients who are sleeping rather than engaging in daytime schedules.
Preventing Infection: Night Nurse Surveillance
Recognising the Blues
This conference is to offer nurses who work regular or intermittent night duty shifts an opportunity to learn about a range of clinical and professional topics that can be applied to their particular context of practice.
People Die at Night – What Can I Say?
Nursing and Social Media: Should Nurses Share?
Mon 25 and Tue 26 | Aug 2014 Hotel Grand Chancellor 65 Hindley St Adelaide SA 5000
Forensic Nursing Care: Bridging the Gap
Blood Transfusions at Night: An Update on Best Practice
To register for this conference, enter the QRC at: www.ausmed.com.au/course
www.ausmed.com.au Ph (03) 9326 8101
Ausmed Education Online Learning | Conferences | Publications
World Call for safe staffing levels in UK
Racism concerns in American health care Americans from minority ethnic groups may be facing racist attitudes and beliefs that can unintentionally affect their medical treatment, according to a review of health care providers. The review looked at interpersonal racism perpetuated by health care providers, rather than internalised, systemic or institutional racism. The review assessed attitudes towards race held by physicians, nurses and allied health care professionals, as well as support staff such as nursing aides involved in direct patient care.
Nurses in the UK should not have to look after more than eight patients at any one time, according to the body that sets NHS standards. The National Institute for Health and Clinical Excellence (NICE) released its draft guidelines on safe staffing for nursing in adult inpatient wards in acute hospitals in response to the Mid-Staffordshire Trust scandal. “Following on from the Francis and Berwick reports, the Department of Health asked NICE to develop evidence-based guideline to advise the NHS about safe staffing,” said NICE CEO Professor Gillian Leng. The guideline recognises that if each registered nurse cared for more than eight patients during the daytime on a regular basis, there would be an increased risk of harm. It stressed the importance of checking if patient’s needs were adequately being met in these situations. The guidelines state that the lead nurse should consider any ‘red flag’ events as indictors of the ward becoming in danger of being understaffed and should then tailor the number of available nursing staff as needed. ‘Red flag’ events include patients not being provided with basic care requirements such as help with visits to the bathroom, being asked about their pain levels or delays in providing medicines.
Professor Leng said there was no floor or ceiling number on the required number of nursing staff that can be applied across the whole of the NHS. “What the safe staffing advisory committee concluded was that assessing patient needs was paramount when making decisions about the number of nursing staff and planning should allow for flexibility on a day-to-day or shift-byshift basis.” The union representing nurses in the UK, UNISON, said the guideline fell short. UNISON Head of Nursing Gail Adams said the most effective mechanism to ensure patient safety is the introduction of national, mandatory, minimum staffing levels on wards. “There is safety in numbers when it comes to caring for patients and that means legal staff patient ratios.” In a recent survey by the union, 65% of nurses said they did not have enough time with patients and 55% said that care was left undone as a result, while 45% of nurses were caring for eight or more patients. “We do welcome NICE’s recognition of the link between caring for eight patients or more and the increase in risk to patients,” said Ms Adams. “But it’s a shame that it falls short of calling for a national mandatory minimum.”
Most of the 37 studies were conducted in the US. Melbourne University researcher Mandy Truong said 26 of the 37 studies published between 1995 and 2012 show evidence of racist beliefs, attitudes and practices among health care providers. “This review provided evidence that health care provider racism exists, and demonstrated a need for more sophisticated approaches to assessing and monitoring it.” Studies included in the review found providers had less positive perceptions about black patients in relation to level of intelligence and compliance with medical advice. It was also found that doctors had an implicit preference for white Americans relative to black Americans. The findings of the review have substantial relevance to medical and health care provision, said Ms Truong. “There is an ongoing need for more sophisticated approaches to assessing and monitoring health care provider racism. Strategies could include greater education and awareness of the health consequences of racism as well as a more rigorous and sophisticated approach to monitoring racism among health care providers.”
PAGE 13 June 2014 Volume 21, No. 11.
They may have started their careers as a South Australian assistant in nursing and a Victorian registered nurse, but ANMF Federal Secretary Lee Thomas and ACTU President Ged Kearney have gone on to become two of the most powerful women in Australia’s union movement. They sat down with ANMJ reporter Kara Douglas to talk about the lessons they have learnt and the challenges they have faced along the way. Q: Outside of the ANMF, men hold the majority of senior roles within the union movement. What are the challenges women face in reaching those senior positions and what can be done to improve the gender balance at the top? GED: Women now make up more than half of all union members in Australia and yet we still don’t see that many women in leadership roles. I think a lot of things have to change starting with women themselves. I think women have to tell themselves they can do it. It’s hard, I’ll be honest. I know what it’s like to walk into a room full of men and for a sole woman that can be quite intimidating. Sometimes when you speak up in a room of men you are not heard and often you think - did I just speak? Sometimes you’ll find that often a man repeats what you said and you think - well why do they all listen to him and pat him on the back? So my advice and what I’ve learnt to do is to call that. I don’t think men mean to be sexist in that manner, they’re not looking to put you down, I think there’s just an inherent culture that we’ve got to break out of and to do that women have to call it. I’ll actually say: ‘I just said that’. Lee’s very good at doing that too, I’ve heard her actually do that in various forums. The other thing is to have confidence to put yourself forward in situations, practice a lot and put yourself through courses if you think you need it. I’m also a big supporter of affirmative action. There are a lot of people against affirmative action, who say women should get there on their own merit but I think that’s rubbish because there are a lot of men’s clubs around. I remember when I put that argument [against affirmative action] to former Victorian Premier Joan Kirner she said to me: “Ged do you really think that every man in every position of power, in every seat of parliament, on every board got there on merit? I don’t think so.” PAGE 14
It’s a good quote. Women need to support each other and I’m a firm believer in affirmative action, something has got to break that cultural mould. LEE: I completely agree with Ged. Another thing that may stop women from seeking higher positions in unions is that your public life is immediately on display and I do think that that is something that some women, and some men too, would not enjoy. That’s just how it is, it goes with the turf and you have to get over that. But the reality is these jobs aren’t family friendly. Ged travels every week of the year, I travel every week of the year. If we had little kids, that is a lot to ask of a partner or a mother, or a mother in law or having to put your kids in childcare. I think flexibility is really important and there are some systemic things that stop some women, but I do think you also have to be as bolshy as buggery in these jobs. GED and LEE: (Both laugh) LEE: (Turns to Ged) Well I think that’s it, isn’t it? You have to be able to tell a Prime Minister they’re wrong when you know they’re wrong. GED: (Laughs) Lee is much better than me at that, can I just say (more laughter). LEE: I have told a Prime Minister that they were wrong and I had the evidence to back it up. We’re here to improve the lot of our members and for those of us in the nurses’ and midwives union that’s about nurses, midwives, assistant in nursing, but we’re also advocates for health consumers. So if you’re going to stick up for people and you’re going to stick up for what is right then you’ve got to have the evidence to back you up and you’ve got to be able to put it out there in a plausible and defensible case. It doesn’t really matter who your opponents are, you’ve got to able to tell them that they’re wrong if in fact they are.
Q: You’ve become two of the most powerful women in the union movement and have achieved a great deal during your careers. What are your proudest achievements? GED: I think one of the highlights has been something I teamed up with Lee on and that was ANMF’s Because We Care campaign. It was an amazing campaign that really highlighted the work and the undervaluing of aged care nurses in this country and it was a fantastic chance for us as the leadership of the ANMF to bring the federation together and work as one. Before that we had, quite rightly, very fiercely independent branches. But that campaign was something we could really work on together and show the power of working as a federation.
That was a very proud moment for me and of course the other one is becoming ACTU President (laughs) that’s a pretty great achievement and again a lot of that was due to the support I got from great people at the ANMF. LEE: The first time I was elected in South Australia as the Branch Secretary is definitely one of my career highlights. It was a contested election and I was contested by two men and I won that election. I had only been working in the union movement a very short period of time and I was pretty proud of that. I started my career as an assistant in nursing in aged care, so given where I’d come from, there is no doubt that being elected as the PAGE 15 June 2014 Volume 21, No. 11.
Federal Secretary of the Australian Nursing & Midwifery Federation was also a particularly proud day. And I think Ged’s right that to be able to move our national executive to form a national campaign, when previously it was just completely impossible to achieve, was amazing. GED: It was pretty amazing and we made a great team. LEE: No doubt about it and we made some inroads into aged care, which of course subsequently have all been unpicked by the current federal government, which frankly is appalling. But interestingly, the executive has been meeting again to talk about how we might move aged care again through another national campaign. It will be different from Because We Care but again it’s got some of those important facets about decent wages and good outcomes for our members working in the sector, who are still appallingly paid with shocking staffing levels and looking after some of the most challenging people in our communities. Q: What are your plans for the future? GED: It’s really hard for me to think beyond the immediate future. We have a two, five and ten year plan for the movement and I’m definitely focussing on that right now… and I’m hoping to get a holiday in there! (laughs).
But I do think we have an obligation to renew our unions and one of the things I think is important is that we have succession plans in place as well, that we start to identify those young nurses and midwives and get them into the union offices. You never know, one of them might end up the Federal Secretary of this union or the ACTU President one day. So while my plans probably aren’t as clear as Ged’s, I know that I’m here for the long haul, as long as the democracy of the union continues to elect me. Q: What is your advice to those young nurses and midwives wanting to develop a career in the union movement?
GED: (Laughing) If you’re old what does that make me!
GED: I really enjoy being in an advocacy role. As Lee said, it’s a fabulous privilege to do what we do. So first of all embrace that and nurses in particular are very good at that. They are good communicators, they’re tough, they work hard and they know what it means to advocate, so believe that you can do it.
LEE: (Also laughs) You’re younger than me… but seriously I’m going to stay as Federal Secretary of this union as long as I possibly can. It’s a great job and I’m lucky to have it.
Don’t be put off, don’t be deterred. Be determined and I think nurses are determined people. I think they’re natural leaders. Put your name up, put your foot forward and believe in your abilities.
LEE: I’m an old girl…
LEE: If you’ve got a passion for advocacy then union work and this sort of advocacy work is amongst the best you can get. Be determined, have a vision for your future and if that’s part of the union movement, then go for it. GED: Also, if opportunities come your way – take them. LEE: Definitely. Look at where our opportunities have taken us. Opportunity knocks on your door sometimes and you have to be in the right head space, or be the sort of person that’s prepared to take a risk. I started on a nine month contract as an organiser at the South Australian branch in 1997. Who would ever have thought back then that from that nine month opportunity, 17 years later I’d be the Federal Secretary of this union? GED: And surround yourself with good women. LEE: Absolutely.
Industrial Nick Blake, Senior Federal Industrial Officer
Plans to deregulate migration arrangements threatens grads The Australian government has established an expert panel to undertake a review of the existing regulations applying to employers who wish to bring migrant labour into Australia. The government committee is primarily investigating claims by some large and vocal employer that there is too much regulation and red tape preventing employers from easily accessing migrants to meet their labour market needs. This is a concerning development because until now it has been broadly agreed by all political groups that the skilled migration arrangements presume that employers should only seek to use overseas labour when there is no local worker available to fill the position and the regulations are there to ensure that Australian employers do not seek to by-pass their local work labour workforce.
We recognise that in many cases the motivation of work in other countries is linked to more attractive employment opportunities including higher salaries, better working conditions and improved capacity for career advancement. And increasingly the opportunity to live in a better and safer environment for themselves and their families is an important factor. The ANMF favours permanent migration but recognises there is a place for temporary skilled migration programs to meet short term unexpected skilled shortages. However, we do not support the continuation of skilled migration in circumstances where locally trained nurses and midwives are unable to find employment. Unfortunately over the past few years there has been a consistent and chronic underemployment of Australian nursing and midwifery graduates despite the employment of large numbers from off-shore.
However notwithstanding these arrangements, Australian employers recruit thousands of overseas nurses and mid-wives at a time when many new nursing and midwifery graduates find it difficult to secure employment.
And sadly it is the case that an increasing number of new graduate nurses and midwives struggle to find employment in their chosen profession, in many instances rejected by the same employers who use temporary skilled nursing labour from overseas.
The ANMF has raised these concerns with the government panel urging them to resist any calls for further deregulation that will remove or dilute current obligations that favour the use of local labour. A full copy of the ANMF submission is available at: http://anmf.org.au/documents/submissions/ANMF_submission_to_the_457_ Review.pdf
The ANMF estimates that:
We do have concerns about the potential impact of deregulating skilled migration however, the ANMF remains a strong supporter of ethical migration and the fair treatment of migrant nurses in Australia. Our union has always supported the geographical movement of nurses and midwives. The professions have a strong tradition of its international collaboration with nurses and midwives moving around the globe to gain further training and different clinical experiences. There is also clear merit in international exchange and diversity, as well as the economic benefit of remittances and transfers in technology.
• In 2013 60% of the Tasmanian nursing and midwifery graduates could not find work; • In Queensland only around 28% of new nursing graduates secured positions with Queensland Health; • In 2013 800 graduates in Victoria, 400 in Western Australia and 200 in South Australia could not secure positions. In our view, the failure of our economy to provide work for our new graduates at a time when employers continue to access large numbers of off-shore nurses and midwives demonstrates a disconnect between the current policy environment that makes possible access to off-shore labour when an Australian worker is not available to fill the position and the available supply of new graduates to our health, aged and community service industries. Putting aside the demoralising and devastating affect this has on new graduates who are unable to find work after completing a three year tertiary course; it also represents a loss in
investment to the education of professional health workers and a loss in the contribution of potential workers to the health and aged care systems. And if not stemmed will represent the lost generation of Australian graduates to our health and aged care sectors. In preparation of our submission we called on new graduates to tell their own stories and a selection of these have been included in the submission. The response was overwhelming with more than 200 new graduates taking up this opportunity. Graduate responses confirms: 1. L arge numbers of new graduates fail to find employment in their field; 2. M any graduates receive numerous employment rejections, in one case over 70; 3. M ost graduates fortunate enough to obtain employment are engaged on a precarious basis through agency, part time or casual arrangements; 4. M any graduates go to extraordinary lengths to obtain work, for example by moving interstate and separating themselves from their families; 5. M ost new graduates are saddled with a HECS debt and many believe their university course was a complete waste of money; 6. M ost employers named in the responses as rejecting new graduates for employment use off-shore labour. The government panel is expected to present their report and recommendations by June 2014 which will be available on the ANMF website (www.anmf.org.au). Finally in our continued support for new graduates the ANMF has commenced a campaign titled ‘Nursing Grads Need Jobs!’ Details of the campaign are also available at the ANMF website.
PAGE 17 June 2014 Volume 21, No. 11.
Laura Irving and Ryley Molloy with patient. Photo courtesy of Mr Ian Hitchcock, Medical Illustration Department, Townsville Hospital and Health Service PAGE 18
Compiled by Professor Linda Shields Professor of Nursing – Tropical Health, James Cook University and Townsville Hospital Health Service
The idea that all registered nurses (RNs) should give so-called ‘basic care’ is a non-negotiable part of every RN’s role. However some concerning comments about how this is not so, made by RNs in a busy medical ward, caused us concern. We are a team of crusty old academics, balanced by two young practising RNs. This feature is a ‘conversation’ we have had about this issue. We question how this primary part of every nurse’s role has come to be seen as something that not all need to do. We raise questions about nursing education and about the culture of nursing in health facilities with the aim of stimulating debate and discussion. Nursing has been around for centuries and is at various stages of development as a profession across the world (Shields 2013). Debate about its development has always been a part of nursing’s progress to recognition as a profession. But the debate has been fuelled by recent reports from the United Kingdom (UK) about the degeneration of nursing there (Shields & Watson 2007; Watson & Shields 2009; 2011; Shields, Purcell, & Watson 2011; Francis 2013). We are nurses concerned about the effect of this ongoing debate about nursing and its education and the impact this has on patient/ client outcomes. Some of us are senior academics, who, possibly, have a vested interest in promoting the debate. To provide balance, a practising clinical nurse on a medical ward, and a nurse who graduated 18 months ago, and now works in the emergency department, provides significant insight to this discussion. We examine differing perspectives on lingering, clichéd debates about nursing, most notably that university education does not encourage nurses to provide ‘basic care’ and that nursing education should return to hospital-based apprenticeships. This discussion presents each author’s opinions and views to provide points to ponder, discuss and debate.
Professor Linda Shields, Tropical Health Nursing, James Cook University, Queensland: Specialty research in clinical areas Recently I overheard an exchange between a patient’s visitor and two RNs in a medical ward. The patient was incontinent of faeces and the visitor asked the RNs if they could clean him up. They said “this was not an RN’s job”. After much fuss, they did grudgingly do so, but this raises the question ‘where did they learn to think like that?’ Any RN is educated to believe that so called ‘basic care’ is an integral part of their work – that all patients require and deserve the dignity of the provision of the commonly needed facets of nursing, such as cleaning, bathing, toileting. RNs are also taught these occasions which provide valuable opportunities to assess a range of the patient’s physical and psychosocial abilities and needs. They are taught the critical reasoning and problem solving to be able to use information thus gleaned as a way to ensure the patient’s needs are met. A straw poll of university nursing courses in Australia confirmed that these skills are taught early in the curriculum and reinforced throughout the course, both in the classroom and in clinical settings. At the recent Australian Nursing & Midwifery Federation’s annual delegates conference the old catch cries arose of nursing graduates not being able to ‘hit the ground running’; calls that ‘students at university do not do enough clinical practice for them to learn how to give ‘basic care’’ and that ‘universities do a bad job of teaching ‘basic’ skills to nursing students’. We have heard such things repeatedly over many years, but we have never found a university that does not teach the so-called ‘basic’ care, nor do they ever say that ‘basic care’ is not part of an RN’s role.
PAGE 19 June 2014 Volume 21, No. 11.
Nursing has been around for centuries and is at various stages of development as a profession across the world (Shields 2013). Debate about its development has always been a part of nursing’s progress to recognition as a profession.
Professor of Nursing Melanie Birks, James Cook University, Queensland: Specialty teaching and learning in research and education I’d love a dollar for every time I’ve heard ‘you can’t learn nursing in a university’. Really? It is an expectation that doctors are university educated but those who spend 24-hours-a-day with the patient are expected to be better prepared for the role via an apprentice-style training model? You can learn nursing in a university, as did most nurses currently employed in this country. We teach and reinforce fundamental nursing skills in pre-service programs. What’s more, we teach principles of practice that enable graduates to transfer their knowledge to a variety of clinical settings. So what’s going wrong? Has the belief that ‘good’ nurses can’t be produced in a university become a self-fulfilling prophecy? Or is it simply that the professional socialisation that occurs in the workplace is eradicating the extensive skills set that we instil in our graduates? My own, and others’, research raises questions about discrepancies between what we teach and what nurses use in practice. Numerous factors feed this trend. Time pressures, scope of practice confusion and lack of confidence all contribute. While the problem itself is manifested in the clinical setting, there is no suggestion that we, as academics, don’t have an obligation to address the issue. We have a responsibility to ensure that health services are prepared to receive and nurture the new graduate. More importantly, the onus is on us to inculcate resilience into our students. Resilience fortifies the new graduate against the temptation to conform to practices that their educational preparation tells them are questionable. The theory-practice gap is fed when nurses accept the disparity between what they know and what they do. Blame cannot be laid solely at the foot of the university. The gap needs to be closed from both sides. PAGE 20
Registered nurse Ryley Molloy: Emergency Department, Townsville Hospital, Queensland I have been nursing for just over 18 months, and I am deeply saddened to hear of others who do not value the importance of the ‘basic care’ that patients need. I am inherently aware and accepting of the fact that ‘basic care’ is a necessary part of being a nurse. Basic care was drilled into me as a student in university, and I well understand that it is a fundamental part of assessing, and building a rapport with my patients. I can honestly say that I have not ever come into contact with a nurse, whether assistant, enrolled or registered nurse who has indicated that basic care is not their job. As a student and a new graduate, I encountered nurses who declared themselves unimpressed at having to toilet or shower a patient, but never once did they indicate that they thought this was for someone else to complete. My experience as a new nurse has been that the majority of basic care has fallen upon me. Usually, I have been paired with a more experienced nurse, and in a time-constrained environment such as a ward, the more ‘difficult’ tasks such as dressings and taking bloods are undertaken by those with more experience than me. However, I know of other ‘new’ nurses who were allocated to specialities that allowed them to spend time gaining new skills, without the need to focus on basic care. I would like to know the background of the nurse who thought that basic care was not her/his job. Was it an experienced nurse who normally delegated these tasks to their newer counterparts? Or was it a ‘new’ nurse who had worked with others that completed basic care so that they could have the opportunity to focus on, and develop new skills?
Editor-in-Chief, Journal of Advanced Nursing and Professor of Nursing, Roger Watson, University of Hull, England It is incomprehensible what was going on in the mind of the nurses referred to in Professor Linda Sheild’s comments [first conversation], but these stories abound and, of course, those who disparage a proper, that is, a university-based education for nurses are quick to generalise from the particular and apply this to all modern nurses and all modern nursing. In recent years the argument has turned from whether or not a university education is needed to be a good nurse, (there is a valuable and unresolved debate to be held about that), to one where university education is to blame for all the nursing’s ills. This debate would be pointless as it is based on something that simply cannot be true. How can the fact that someone has been educated in a university make them a poorer carer? The so called ‘basic’ skills are taught and, of course, anyone who stops to think about the issue and actually observe nursing care will realise that the vast majority of nurses are doing a good job in increasingly difficult circumstances. When a doctor makes a mistake or deliberately does something to harm a patient we do not blame the system, we blame the doctor. Why do we blame the system for the, often exaggerated, faults of a few nurses? There are things wrong in nursing. My father spent many of his final weeks in hospital and I never ceased to be appalled that nurses were not actually paying attention to the patients. It is a cliché but the nurses literally sat at the nurses’ station and had to be coaxed into the patient areas by relatives or, largely ignored, call bells. A failure to manage the clinical area properly, and to set a good example by senior staff; it was a ‘culture’ and, since the Mid-Staffordshire scandal (Francis 2013), we know how strong and toxic a culture can be. It is too easy to say, as I did, that ‘this would never have happened in my day’. I recall some appalling standards of care, especially of older people and people with learning disabilities, from my early days as a nursing auxiliary and then as a student nurse. We won’t resolve the issue here, but I suggest there is something wrong with the notion of ‘basic’ care. Simply changing the name (I prefer the description) ‘essential care’ - will not transform nursing. However, words are powerful and can at least begin that transformation. ‘Basic’ suggests that something is easy, that it can be skipped in favour of the heroic or something ‘worthwhile’. It also suggests that it can be done by someone else.
Professor of Nursing David R Thompson, the Australian Catholic University, Professorial Fellow at the University of Melbourne, and Adjunct Professor at Monash University, Victoria Rather depressingly, I have heard and, as a patient, experienced the sort of response described. Indeed, the nurses who nursed me knew I was a nurse and I assumed they were giving me their standard of ‘good care’. But, if that was the case, what were the other patients getting? We constantly hear patients, relatives, doctors and nurses, as well as the media, recounting experiences of poor care, which inevitably result in knee-jerk reactions, placing the blame on university-based nurse education and calls to revert to the old hospital-based system of nurse training. Many hark back to those supposedly halcyon days of nursing where all were concerned only with ensuring the highest standards of care - an era that, in reality, probably never existed. Arguably, the situation was no better then but patients and their relatives had different, usually lower expectations, were loath to complain and were invariably full of gratitude to nurses simply for ‘being there’. We now know from evidence that better-educated nurses are usually associated with better patient care (Twigg et al. 2013). The notion of ‘basic’ care implies something that is simple and easy rather than fundamental, essential, necessary. Doctors don’t talk of ‘basic’ treatments. Nurses deal with complexity all the time. Nursing operates in complex health care systems and focuses on caring for patients with complex health problems, which are addressed through complex interventions. Inevitably, in a system where patients - who respond in unpredictable and uncertain ways - are central, there will be instances of regrettable but uncommon instances of poor care. What is needed to improve patient care (including health outcomes, safety and experience) is to remind organisations (health services and universities) to refocus and put the patient at the centre of all they do, to enhance quality and nurture a caring culture in which the core values include compassion, patient dignity, trust and respect. This involves appointing influential and credible nurse leaders, hiring sufficient numbers of well-educated nurses who feel valued, respected, engaged and supported, and report mistakes, irrespective patient harm. This should be circumscribed by an ethic of learning (surely the central role of a university education) and integrity. Only by such means can we hope to practice the highest standards of care.
‘Essential’ care suggests some urgency and importance in the matter; something that needs to be done now, by you and if it is not done then the rest of your efforts are worthless. It’s a start.
PAGE 21 June 2014 Volume 21, No. 11.
Professor of Nursing Philip Darbyshire, Monash University, Victoria, Flinders University, South Australia, and Director of Philip Darbyshire Consulting Forget Houston, ‘Nursing: we have a problem’. For several years I have been speaking and writing about the ‘crisis in care’ (Darbyshire 2013) exemplified by Francis (2013) and other reports from the UK and elsewhere and reinforced by numerous discussions with nurses worldwide. I regularly ask conference audiences if they believe that this thing called ‘basic nursing care’ (regardless of how we may wish to re-brand it) is (a) better, (b) about the same, or (c) worse than it was 10-15 years ago. Every audience has responded overwhelmingly with (c) worse. I don’t mean just by a few hands, I mean by a forest of arms. This is not goldstandard evidence, but is enough to worry me and many other nurses. This crisis is real, not some media beat-up and planting a few good news stories won’t neutralise it. There is a world of difference between bad care and bad press. To stop appalling care stories appearing, we might try preventing appalling care from happening in the first place. In the UK, many inquiries have found nursing to be in a parlous state there. Clwyd and Hart’s (2013) report into patient complaints noted that: “… a significant number (including many former nurses) believed that the quality of nursing care is in decline, because of changes in the role of nurses and in their training and professional ethos. The observations or criticisms included: a belief that nurses are not as disciplined as in the past; are not properly supervised; are not sufficiently compassionate; are too focused on the ‘technical’ side of nursing; lack a sense of responsibility towards their patients; and are seen not to be prepared to do everything necessary to ensure the right level of care, whatever the lack of resources or competing demands on their time.” Calling the nursing education/training discussion the “university debate” over-inflates a non-issue. I cannot understand, nor have I ever heard any justification for why every other health (or other) professional, apart from nurses, needs a university education. Bad doctor stories do not lead to public calls for scrapping medical schools. The Francis Report’s (2013) evisceration of lamentable standards of management, leadership, governance and audit have not resulted in calls for university business schools to be closed or MBA programs abandoned. University per se is not the issue, rather how well today’s nursing programs prepare students to plan, provide, assess and champion ‘basic/ fundamental/essential nursing’ and how well they work with clinicians to make such good ‘basic care’ a non-negotiable ‘line in the sand’ standard. Saying ‘but we teach this’ doesn’t work if students/staff are not learning and doing it, nor does passing the buck to the world of clinical practice. This is, remember, the same clinical world with whom schools of nursing ‘partner’ in their brochures and websites within a puffy cloud of ‘seamless cooperation and integration that ensures optimal clinical experiences and the real world relevance of your nursing qualification’. When asked to consider which part of this crisis they own, many schools delude themselves into thinking that they are not to blame (Darbyshire & McKenna 2013). Until we have more honesty and insight in both nursing practice AND education, the stories and reports will continue. PAGE 22
Clinical Nurse Consultant Laura Irving: works on a medical ward, Townsville Hospital, Queensland As a university-educated nurse I know that the education program is not responsible for the re-defining of the nursing role that seems to be occurring, as demarcation lines around roles are blurred. What were once roles of doctors, for example cannulation, intravenous medications, ECGs, etc, are now left for nurses to absorb into their roles, possibly negatively skewing the importance of ‘basic care’ and placing higher emphasis on these ‘new’ skills. People generally choose to become nurses because they genuinely care for other people. Most nurses I know are simply too busy to provide this basic level of care. In the nursing world priorities have changed. Health care systems are increasingly complex with advancing technology and greater numbers and acuity of patients. Health care is now a business, performance must be measured and targets achieved, with fiscal penalties for non-compliance. Despite increasing workloads and rapid patient turnover there remains a number of tasks to be completed in a set timeframe, leaving little time for caring. Nurses are now responsible for tasks previously reserved for medicine, and associated with greater status. Nurses want to read ECGs, insert cannulas and perform other ‘doctoring’ stuff, associated with perceptions about advancing their status. Following graduation, nurses are quickly socialised into this culture. When a student, you’re delegated the supposed ‘tedious’ tasks such as washing patients, making beds and endless rounds of taking obs. Students can’t wait to hand out medications, change IVs, dressings, drains and perform all the ‘real’ nursing duties. Once one has climbed a rung on the status ladder no-one wants to go back. Additionally, the advent of litigation has brought the requirement for completion of multiple forms: admission forms, risk assessment forms for pressure injury and falls, early warning charts, physical assessment forms, forms for assessment of cannulas and intravascular devices, management pathways, care plans and progress notes to be completed for every patient. Legally, if it’s not written down then it wasn’t carried out. However, if the nurses are busy filling out the forms, this removes them from the patient’s bedside. We need to evaluate what we want from our nurses. Is it feasible to educate someone to degree level to provide the “essential” care and make beds? Or in this cost effective world can we employ lesser trained nurses (not untrained) receiving direction from a RN, who have fewer complexities to address, and can focus on the essentials? We have educated our modern nurses to a higher degree than ever and perhaps we should reassess their purpose and our expectations, while acknowledging the gap this has created.
ANMF response – Assistant Federal Secretary Annie Butler The ANMF welcomes meaningful debates and discussions on the profession of nursing and the best directions for its future. So we are pleased to contribute to this conversation on the role of the registered nurse within the nursing team. However, we make our contribution to this conversation noting that the previous contributors have spoken anecdotally and occasionally referenced isolated examples, so not all experiences may be generally applicable. Many of us can probably report hearing a range of views expressed about current registered nurse practice and basic nursing care over time. But it does seem that ‘bad news’ stories so often get a hearing while the many occasions of exemplary care seem to go unnoticed. Of course, this is not entirely true – nurses have just been voted, for the twentieth consecutive year, as the most trusted and ethical profession by 91% of the community. This must give an indication of what people actually think of our profession, the majority of which has now been university educated. So let’s consider some of the issues raised in the conversation pieces regarding the expectations of some towards our newly graduated nurses, as well as some of the factors that don’t often seem to be explicitly considered. It has most likely been the case that, irrespective of the era, there have been some nurses not so engaged with the less glamorous aspects of nursing care. A number of us may have stories we could tell in that regard. So this is most likely not unique to the university educated nurse or contemporary nursing practice. The possibility, as CNC Laura Irving explains, that on too many occasions current health care contexts just do not allow time for nurses to attend to every single aspect of nursing care is a real one. It is without question that the technological advances of the last few decades now see routine nursing care comprising increasingly sophisticated procedures and interventions. Registered nurses have therefore necessarily had to become much more technically focused just to perform their ordinary roles.
Conclusion The profession of nursing is at a critical juncture, with a fundamental debate needed about how to produce the best education for the best nurses and the best patient/client outcomes. We have presented several different perspectives, and have suggested how nursing could change its culture to be able to develop further. References Aiken, L., Clarke, S.P., Cheung, R.B., Sloane, D.M., Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mobility. Journal of the American Medical Association, 290, 1617–1623. Clwyd, A., Hart, T. (2013). A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. Final Report. www.gov.uk/government/uploads/system/uploads/attachment_data/file/255615/NHS_complaints_accessible.pdf Accessed 13 February 2014. Darbyshire, P. (2013). The Mid Staffordshire Trust scandal and the Francis Report: could it happen here? Paper presented at 2013 Professional Issues in Practice Conference, Melbourne. Darbyshire, P., McKenna, H. 2013. Nursing’s crisis of care: What part does nursing education own? Nurse Education Today. www.philipdarbyshire. com.au/images/resources/pdf/nursings%20crisis%20of%20care-%20 what%20part%20does%20nursing%20education%20own.pdf Accessed 13 February 2014. Francis, R. (2010). Independent Inquiry into Mid Staffordshire NHS Foundation Trust – final report, 24 February 2010. Retrieved from www.midstaffspublicinquiry.com/sites/default/files/First_Inquiry_report_volume_1_0.pdf Accessed 13 February 2014. Shields, L. (2013). The core business of caring: a nursing oxymoron. Collegian, http://dx.doi.org/10.1016/j.colegn.2013.03.001 Accessed 13 February 2014. Shields, L., Purcell, C., Watson, R. (2011). It’s not cricket: The Ashes of nursing education. Nurse Education Today 31: 314-316. doi: 10.1016/j. nedt.2010.12.015 Shields, L., Watson, R. (2007). The demise of nursing in the United Kingdom: a warning for medicine. Journal of the Royal Society of Medicine, 100, 70-74 Shields, L., Watson, R., Thompson, D. (2011). Editorial: Nursing education in the UK – clocks forward or clocks backward? Journal of Clinical Nursing, 2011; 20:2095–2097 doi: 10.1111/j.1365-2702.2010.03341.x Twigg, DE., Duffield, C, and Evans, G. (2013). The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards. Australian. Health Review 37, 541–546. Watson, R., Shields, L. (2009). Cruel Britannia: a personal critique of nursing in the United Kingdom. Contemporary Nurse 32(1-2): 42-54
This doesn’t mean that nurses have become less caring or even that they eschew basic nursing care. It may just reflect that time is not infinite and when a registered nurse has to weigh up what will have the most significant consequence for the patient’s care, a face wash may seem more dispensable. This is the element of the conversation that is often not made explicit – that extreme pressures of health service requirements and budget inadequacies. Nurses should not be placed in a position where they have to decide which aspect of nursing care will be left unattended because of a lack of adequate staffing. Issues of unsafe care or care below the expected standard must of course always be addressed and rectified. But we must recognise where a decrease in level of care is due to budget deficiencies and organisational pressures – these too must be addressed and rectified. Nurses should not be expected to shoulder the burden of these shortfalls. Instead, nurses should be able to practise in environments which are supported by mandated arrangements for safe staffing and reasonable workloads, adequately funded by governments. We need to use our collective strength to pursue these goals for the sake of our profession and the health of our patients. PAGE 23 June 2014 Volume 21, No. 11.
Reflections Ely Talyor
Learning from clinical leaders
I was lucky to sit down and have a chat to one of our CNCs Nadia Burkolter about what it meant to be a clinical leader in our current health care environment and when comparing it to the current literature, Nadia was right on the mark. Three major themes developed which I have highlighted below, although a constant theme came out throughout our conversation which was her commitment and passion for nursing: “It is not just a profession but a way of life.”
Continuing professional development L-R Ely and Nadia
In a busy and demanding acute care environment one can spot a clinical leader just by their presence. In the neurology department at the Royal Prince Alfred Hospital (RPAH) we are lucky enough to have four Clinical Nurse Consultants (CNC) that are dedicated to the nursing profession and always willing to help further the knowledge and careers of new nurses.
“In Nursing, it’s not just about professional development but about personal development,” Nadia explained. “Because of this, sometimes you need to go the extra mile in your own time and with your own funds”. In nursing the phrase, ‘you learn something new every day’ is pertinent. However, it is the clinical leaders amongst us that celebrate this and remind us of the complexity of each individual and what we can learn in a mutual therapeutic relationship. Nursing is constantly evolving with new research and new treatments (Strech & Wyatt 2013), and it is because of this that many clinical leaders including Nadia have gone back to complete extra studies in their chosen area. However, Nadia expressed that it is not always about how many certificates you hold but rather the experiences and diversity of your experiences. She advised the need to actively seek opportunities and always acknowledge that you can learn from any situation. A broad range of leadership development programs, personal experiences and formal studies contribute to improving leadership capabilities and making the workforce more sustainable (MacPhee et al. 2012).
It is integral to the role of a clinical leader to be able to motivate others and share their knowledge with the nursing workforce to achieve mutual goals (Curtis & O’Connell 2011; Davidson, Elliot & Daly 2006). Nadia explained it is about trying to inspire people to act themselves. This is consistent with studies that have shown that empowering people in their own practice enhances motivation and decreases resistance to change (Supamanee et al. 2011; Curtis & O’Connell 2011). Furthermore, Germain & Cummings PAGE 24
(2010) found that leadership behaviours and practices have a direct influence on staff performance motivation and create a positive work environment. Nadia expressed the importance of having high levels of integrity when motivating people, stating “we need to lead by example” and to “help others gain an insight into why we do things a certain way”. This is vital in nursing as it is the clinical leaders that often pass down knowledge of changes in evidence based practice and teach novice nurses technical skills specific to an area (Clarke & Hassmiller 2013).
Nurses who display high levels of resilience are less likely to suffer from burnout or emotional exhaustion as they have the ability to overcome and learn from difficult situations and develop coping mechanisms to manage stress (Manzano, Guadalupe & Carlos 2012). Nadia expressed the need to stay true to your values and have a high level of integrity. She summarised the need to have a strong understanding of emotional intelligence to become resilient in the workplace. Emotional intelligence encompasses a range of characteristics including self-awareness, mindfulness of others, impulse control, persistence, and motivation (Rankin 2013). Resilience in nursing is a well-researched topic due to the stressful nature of the job. However how to build resilience in early career nurses has been a more complex discussion with research indicating that structured programs should be implemented to help early career nurses discuss their experiences with trauma, death, life transitions and acute and chronic illness (McDonald et al 2013; Dean 2012). Throughout my experience as a new graduate at RPAH the CNC’s have guided, nurtured and inspired my clinical aspirations. This conversation with Nadia was so important to identify certain elements that an early career nurse can use to develop personal leadership capabilities.
References on request Ely Taylor is a second year registered nurse at the Royal Prince Alfred Hospital, Sydney and a participant in the Australian College of Nursing’s Emerging Nurse Leader Program.
Brought to you by the ANMF and HESTA
If you manage the household budget, you can manage your super Women all over Australia expertly manage their family finances — ensuring they get the best bang for their buck. Bills are paid on time and home life runs like clockwork.
Ready to roll?
And for many, all of this is achieved while managing a job outside the home.
Of course, before you decide to roll your super into one fund, it’s important to compare each fund and ensure the one you choose is right for you. Look at all fees and other charges that may apply when you leave a fund, including exit fees.
Although superannuation can seem complicated, managing your super is actually a lot like managing the household budget. It’s about setting goals, understanding your limits and planning to achieve the best outcome. If you have the skills to manage your household budget, you can manage your super. Here are a few tips to help you get started.
Combine your accounts – you can now do it online! Many of us have changed jobs at some stage or another. Did you take your super account with you to your new job? Many don’t — super just wasn’t on their radar at the time. But having multiple super accounts means paying multiple fees. Never mind the effort and paperwork involved in keeping track of numerous accounts!
If you think you may have more than one super account, you can visit ato.gov.au/superseeker to find out.
Funds also differ in the insurance cover and investment options they offer. You should check if you can have at least the same insurance cover with the fund you are rolling into. You should also take into consideration the long-term investment performance of the fund when making your decisions.
Check how your super is tracking Many super funds have online calculators to help members understand how their super is tracking for retirement. Visit your fund’s website to get an idea of how your super’s likely to look when you retire.
Why let your hard earned cash go to waste, when it could be working towards securing your future? Every cent counts — by consolidating your super you can avoid paying unnecessary fees and costs and ensure your super is working for you.
PAGE 25 June 2014 Volume 21, No. 11.
Build it — even a small top up can make a huge difference For most people, super is simply the compulsory payment their employer makes on their behalf. But you can also contribute extra to your super from both your before and after-tax pay. Every little bit extra you contribute to super, goes towards helping ensure your retirement is as comfortable as possible. Even putting an extra $20 a week into super, can improve your retirement. If your employer agrees, before-tax contributions can be made in the form of a salary sacrifice. Or, you can arrange to contribute extra from your after-tax pay. Depending on your fund, you can put extra into super by: 1. setting up ongoing direct debits from your bank account 2. arranging regular contributions to super with your employer — they’ll deduct it directly from your pay
Are you one of the many Australians with lost super? Pay a visit to ato.gov.au/superseeker — it’s a secure online tool that helps you keep track of your super.
3. making contributions directly with your fund whenever you can — you may be able to do this online or using a deposit slip.
Extra contributions make a difference Extra contributions make a difference $475,000
You can use SuperSeeker to: • check your current super accounts that money has been paid into in the last two financial years • find lost super held at the Australian Tax Office (ATO) — if the government, your super fund or your employer can’t find an account to transfer your super to, the ATO holds it on your behalf — there is billions in lost super waiting to be claimed • transfer your super to the super account you want to keep. To access these services, the first thing you need to do is register online with the ATO. This is an important security measure to protect the personal information displayed. It also helps to ensure that any transactions are made by you. Registering online will give you access to your super information 24/7.
contribution from age 25
contribution from age 45
No extra contributions made
*Assumptions: StartingStarting employmentemployment at age 25 on a salary $45,000 no money *Assumptions: at ofage 25 p.a. on with a salary ofin super, Investment earnings of 6.25% net per year, insurance premiums of $3.45 per week, retiring $45,000 p.a. with no money in super, Investment earnings of at age 67, inflation of 2.5% per year, and salary increases of 1% above inflation. Figures are in 6.25% net(i.e. per insurance premiums of $3.45 week, retiring today’s dollars the year, final value is discounted for inflation). Figures includeper SG contributions and the co-contribution. calculations starting 1increases July 2014 andof legislation at government age 67, inflation of Figures 2.5%based per on year, and salary 1% current in April 2014. This example is an illustration only and is not guaranteed. Investments may above inflation. Figures are in today’s dollars (i.e. the final value is go up or down.
discounted for inflation). Figures include SG contributions and the government co-contribution. Figures based on calculations starting 1 July 2014 and legislation current in April 2014. This example is an illustration only and is not guaranteed. Investments may go up or down.
Boosting your super is as simple as ABC
A is for making... After-tax contributions B is for making... Before-tax contributions C is for claiming your... Co-contribution
After-tax contributions After-tax contributions can be paid into your account from your after-tax income (your take home pay), your savings or from a lump sum (e.g. tax refund or inheritance). It can be hard to save money, but if you set up a regular deduction from your pay, which your employer pays directly into your super account, you may not even miss the cash. Plus, after-tax contributions could net you a Government co-contribution of up to $500 (described below).
How much can I contribute? In the 2014/15 financial year you will be able to contribute up to $180,000 of after-tax earnings to your super. If you’re under 65, you can roll forward three years’ contributions into one year, to allow a maximum of $540,000. These contributions do not attract tax on payment into your super fund.
Don’t forget to supply your tax file number (TFN) Your fund needs to have your TFN to accept after-tax contributions. Providing your TFN has other great benefits, like: • you won’t have to pay the highest marginal tax rate (plus the Medicare Levy) of 47% on contributions made to your super account/s • you can make all types of contributions to your account, including after-tax contributions (which could make you eligible for a Government co-contribution of up to $500) • no extra tax will be deducted when you start withdrawing your super benefits (other than tax usually deducted from super). It really pays to supply your TFN to your fund so call them now!
Easy ways to make after-tax contributions
Another great benefit of making aftertax contributions is eligibility for the Government co-contribution scheme. Designed to help you save for your retirement, the scheme offers a payment of up to $500. All you have to do is make your own after-tax contribution. If you earn $34,488 or less in the 2014/15 financial year, you may receive the maximum super co-contribution of $500. For incomes over $34,488 and up to $49,488, the co-contribution reduces by 3.33 cents for every dollar and cuts out completely at $49,488. For more information on the Government co-contribution scheme visit ato.gov.au/super Contact your fund or visit ato.gov.au/super to see how co-contributions and salary sacrificing might work for you.
• Deposit your next tax refund into super. • Set up an automatic transfer of just $20 a month to boost your super. • Earned a pay rise? Arrange to have your employer deposit the extra money straight into your super.
PAGE 27 June 2014 Volume 21, No. 11.
Before-tax contributions into super Before-tax contributions include the compulsory super your employer pays on your behalf and any voluntary contributions you make, known as salary sacrifice. Depending on how much you earn, you may save tax by sacrificing some of your before-tax income. Currently, salary sacrificed contributions are taxed at 15% for those on taxable incomes of less than $300,000 per year.
High-income earners Currently, those on taxable incomes greater than $300,000 incur 30% tax on their before-tax super contributions. The definition of ‘income’ includes before-tax super contributions (super paid by your employer on your behalf — Super Guarantee (SG) — and salary sacrifice contributions). However, if your income — excluding before-tax contributions — is less than $300,000 and the inclusion of your before-tax contributions pushes you over the $300,000 threshold, you will only pay 30% tax on the portion of contributions that is in excess of the threshold.
How it works You agree to forego a set amount of your before-tax salary, which your employer pays into your super account with their compulsory contributions.
How you benefit • Income tax savings: by reducing your taxable income, you may fall into a lower tax bracket. • Super tax savings: before-tax contributions, including salary sacrifice and employer contributions — up to a maximum amount as outlined below — are taxed at 15% for those on taxable incomes of less than $300,000 per year, which is lower than most income tax rates.
Depending on how much you earn, you may save tax by sacrificing some of your before-tax income.
How much can I contribute? In the 2014/15 financial year, you can contribute up to $30,000 of before-tax earnings each year (this includes the super contributions your employer makes on your behalf). Those aged 50+ at 1 July 2014 can contribute up to $35,000 of before-tax earnings each year. If you’ve given your TFN to your fund, these before-tax contributions will be taxed at the concessional rate of 15%. Remember to keep track of your super contributions, as exceeding these limits may incur additional tax penalties.
Are before-tax contributions right for you? Before you get started, seek advice on how salary sacrifice might work for you. You should know: • before-tax contributions may be taxed if you withdraw them from super before you turn 60 • they’re included as part of your income when considering eligibility for the Government co-contribution and other government benefits • if you already pay a low marginal rate of income tax, salary sacrifice into super may not be the best option for you.
Sally uses her fund’s superannuation calculator and discovers that if she makes no extra personal contributions to her super (above the contributions her employer makes on her behalf), she may have only around $153,802* ($101,078 in today’s dollars), including interest, when she retires.
HESTA super account balance
Plans to retire at
Reviewing her budget with her fund’s budget tool, Sally realises she can afford to add $20 per week after tax to her super account. The extra $20 per week means Sally’s super could reach around $195,230* ($128,304 in today’s dollars) by the time she’s ready to retire. By contributing just $20 per week, Sally could be $41,428 better off! Check out your fund’s website for calculators and budget tools that may help you work out how much super you might need, see how you’re tracking right now and the difference before and after-tax contributions could make to your super.
*Assumptions: Investment earnings of 6.25% net per year, inflation of 2.5% per year, and salary increases of 1% above inflation. Figures include the government co-contribution based on proposed income thresholds for the 2014/15 financial year. Figures calculated during April 2014 and includes the 2014/2015 Superannuation Guarantee (employer contribution) rate of 9.5% (based on legislation current in April 2014). This example is an illustration only and is not guaranteed. Investments may go up and down.
Get to know your super If you’ve put your money into a savings account, do you take an active interest in the returns, fees and risks that apply? While most people take an interest in managing their savings, many forget that super is actually like a hidden savings account — for your retirement.
It’s likely your fund offers members a choice of investment options, with varying aims, strategies and levels of expected risk and return. And generally, funds have a default — also known as a MySuper — option to suit the majority of members. So, if you didn’t choose another option when you joined, all your super is likely to have been automatically invested in your fund’s default or MySuper option and will stay there until you decide to change.
The golden rule: invest your money according to your goals and risk tolerance — which may change over time. Make sure you’re comfortable with the investment option your super is invested in. Generally, the options offered by funds cater to the full range of investor types — from ‘cautious’ to ‘aggressive’ — it’s essential to understand where you fit on that spectrum, now and in the future. It may not feel like your money yet, but super is one of the biggest investments you’ll ever make. Understanding how your super’s invested could give you greater control over its progress.
And just like shopping around for the best rate on your savings account, you can take an active role in where your super savings are invested.
Do yourself a favour: get involved with your super Read your fund’s product disclosure statement to find out about the investment options available to you. If you’re not comfortable making investment decisions on your own, seek advice about which investment strategy suits your circumstances. Remember to revisit your choice as your needs change over time.
PAGE 29 June 2014 Volume 21, No. 11.
24/7 access to your account with Member Online Many funds have an online platform that gives members access to their super account 24/7. Depending on your fund, you may be able to use it (together with your fund’s website) to: • update your personal details • change your insurance or investments online • make extra contributions • amend your nominated beneficiaries
Your fund’s education and advice services Check if your fund runs workplace super education sessions or advice for members. Sometime these services are offered as a member benefit at no-extra cost or for a low fee. They can be a great way to access information — on topics such as insurance, making investment choices, your super contribution options, managing money and retirement planning. To help keep your super strategy on track, consider speaking to a qualified adviser who can tailor their advice to your personal situation. You may be able to access personalised super advice through your fund.
• learn more about how super works • check monthly, year-to-date and past investment performance • use online calculators to estimate how much super you might end up with and how long it may last • access advice about super.
Protect yourself (and your family) against life’s ups and downs Know where to get advice if you need it If you get stuck along the way, it helps to know where you can get the right advice if you need it. The good news is thankfully there are many places to find information about super, including:
Your fund’s website Available 24/7, your fund’s website can often be a good place to start when looking for information about super. You may be able to find answers to some basic questions with the click of a mouse.
moneysmart.gov.au The MoneySmart website is run by the Australian Securities and Investments Commission (ASIC) to help people make smart choices about their personal finances, including super. It offers free, independent guidance and tips so you can make the best choices for your money. Use MoneySmart’s range of interactive calculators, not only to work out your super options, but you can also calculate income tax, create a budget, investigate mortgage options and more.
Planning for retirement is an important part of protecting your future. But life doesn’t always go to plan. Insurance is there for those things you can’t plan for. Your health and ability to earn an income are vital assets that need protection. Many Australians don’t have enough — or in some cases, any — disability or death insurance, exposing their families to financial hardship if they die or suddenly lose their ability to earn an income. Insurance through your super fund can be a costeffective way to protect yourself and your income should the unexpected happen. In general, premiums are deducted from your super account so you don’t need to fund them from your weekly budget. Most funds give members access to income protection, lump-sum total and permanent disablement and death cover — although you may not receive all three automatically.
Options for retirement — you may have more than you think Keen to boost your super and pay less tax? Maybe you want to wind back on work without reducing your income? A transition to retirement (TTR) income stream could be just the ticket. If you’ve reached your preservation age (55 years for those born before 1/07/1960), the Government’s transition to retirement rules let you access your super before you retire. This means you can use some of your super to supplement your income and wind back on work or boost your super before retirement. Date of birth
1/7/60 - 30/6/61
1/7/61 - 30/6/62
1/7/62 - 30/6/63
1/7/63 - 30/6/64
Transition to retirement People continue to work past age 55 for a variety of reasons. Many need the money. Others enjoy the mental stimulation and social interaction their job offers. Some reduce their hours to slowly ease into life without work. That’s why there’s a Government-endorsed strategy — called transition to retirement — that allows you to start accessing your super while you’re still working. Many super funds offer members access to TTR and retirement income stream options. TTR allows you to: • continue working and boost your super for when you retire, taking advantage of potential tax breaks, or • reduce your hours without reducing your income — by supplementing your employment income with your super. And it doesn’t affect your eligibility to continue building your super! TTR restrictions If you choose to take your super as a TTR income stream, you can’t withdraw it as a lump-sum payment until you: • permanently retire from the workforce on or after your preservation age (see table) • end your current employment on or after age 60 • turn 65, whether you’re working or not • suffer permanent incapacity or death. Once you leave the workforce completely, a retirement income stream gives you easy access to your super, under more flexible lump-sum payment rules. If you like, you can use any extra funds you saved to your pre-retirement super account to start another income stream.
Find out if you’re covered Review your latest super statement — it should contain details of any insurance cover you have. If you have insurance, check whether your current level of cover is enough to meet your needs. If you’re not covered, contact your fund to find out what insurance options are available and whether you’re eligible.
The best option for you will depend on your circumstances. Each option has different implications for: • the tax you’ll pay • your income levels • the Government benefits you can receive • the kind of lifestyle you’ll enjoy. So, a TTR strategy needs to be carefully explored and it’s best to get advice tailored to your situation. You may be able to access advice about TTR through your super fund.
Disclaimer Information issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information has been carefully compiled from sources we consider to be reliable. However, it is only current at the time of writing (15/5/14) and may not be accurate in all instances. It is of a general nature. It does not take into account your objectives, financial situation or specific needs. You should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Third-party services are provided by parties other than H.E.S.T. Australia Ltd and terms and conditions apply. H.E.S.T. Australia Ltd does not recommend, endorse or accept any responsibility for the products and services offered by third parties or any liability for any loss or damage incurred as a result of services provided by third parties. You should exercise your own judgment about the products and services being offered. Investments can go up or down. Past performance is not a reliable indicator of future performance. Consider a Product Disclosure Statement before making a decision about HESTA products. Call 1800 813 327 or visit hesta.com.au for copies.
PAGE 31 June 2014 Volume 21, No. 11.
on average, Australian women retire with just over half the super of men?
Consider some everyday ways to save money for super — from HESTA members just like you
That’s because women haven’t always enjoyed the same super rights as men. In fact, until the 1970s, where super was available, some women were even excluded from super when they got married. While super rights for women have thankfully improved, many continue to miss out on valuable super benefits.
• I grow my own vegies, exchange toys & books with kids’ friends, bought a sewing machine to make curtains, cushion covers, pillow cases...
• On average, women are still paid less than their male counterparts.
• My friends and I have wardrobe exchanges — for clothes, shoes, bags. Every six months we swap the items we no longer wear. Saves a fortune!
• The amount of super women can generate is often impacted by career breaks to care for family. • Women have a greater tendency to work part-time or casual hours. Together with the late introduction of compulsory super in 1992, these factors have left many working women at a disadvantage when it comes to their super savings. That’s why it’s so important to take a proactive approach to boosting your super. HESTA CEO, Anne-Marie Corboy, is often called on to speak about women’s super-adequacy issues. The leading fund for health and community services, HESTA has more than $27 billion in assets and over 770,000 members.
“More than 80 per cent of HESTA members are women — many of whom work casual or part-time hours in health and community services.” “By keeping track of your account balance, choosing investment options that meet your needs, and contributing even just a small amount extra, you can get your super back on track,” Ms Corboy says.
• Instead of paying gym fees, I started walking with my daughter. Not only am I still keeping healthy, I’m spending more time with my family. • I’ve organised with four neighbours to shop together to bulk buy, saving 20% each from our weekly shopping (about $30). • I’m taking up sewing lessons with my daughter so we can both trim our wardrobe costs. • Once a month I have a ‘no shop week’ and cook creatively with my pantry and fridge contents = $100 month extra for super! • I’ll get creative with birthday and Christmas presents, getting the kids to make wrapping paper, cards and presents for friends and family. • My family has started a weekly ‘no drive’ day, walking to school, the park and shops. Cutting out 52 driving days a year saves $360 p.a.! • Hairdresser and manicure — my local TAFE has beauty school at 1/4 of the salon price = $$$$ to super! • I’ve planned six evening meals in advance, shopping only once. Buying all the ingredients needed, I will save money and won’t be tempted to buy. • Bringing lunch from home three times a week at $8 per lunch saves $1,152 per 48-week year which, over time, will boost my super exponentially! • I’m compiling a comparison for ALL of my insurance online. I’ve already identified savings for my car insurance, now for my home, contents and landlord insurance! • I’m going old school — baking, preserving, batch cooking and bulk buying. Cut out convenience eating for savings and good health. Longevity and health are the big rewards!
HESTA CEO, Anne-Marie Corboy
Ethics Megan-Jane Johnstone
Preventing ethical conflicts
Over the past decade widespread patient safety concerns has seen the development of a global patient safety movement aimed at reducing the incidence and impact of preventable adverse events in health care and, to this end, taking a proactive rather than a reactive approach to promoting a culture of safety in health care organisations around the world. Commensurate with this development (and in recognition of the fundamental linkage between ethics and the quality and safety of patient care) there has been a resurgence of interest in what is called ‘preventive ethics’ in health care. The idea of ‘preventive ethics’ dates back to the early 1990s and the burgeoning field of bioethics in which increasing attention was being given to ethical issues in the clinical setting. At that time, the limits of clinical ethics were being recognised as was the problem that ‘waiting until a conflict arises makes resolution of ethical quandaries more difficult’ (Forrow et al.,1993). Recognising that clinical ethics ‘do not arise suddenly, but … develop predictably over time’, Forrow et al (1993) proposed a preventive ethics approach as a means to help expand the contributions of clinical ethics and shift attention away from the mischaracterisation of moral conflicts in health care as ‘discrete ethical problems’ requiring crisis management.
A question of nursing ethics
Moral conflicts involving ethical issues in health care are well documented. Moreover, it is being increasingly recognised that such conflicts can ‘undermine the patient’s quality of care, the staff’s morale, productivity and efficiency, and the organisation’s culture’ (Nelson et al 2010). Here the question arises of how might nurses meaningfully contribute to an agenda of preventive ethics in health care?
The ethics-quality linkage
To help remedy the problem of conflict in clinical ethics, proponents of preventive ethics have revitalised Forrow et al’s proposal and called for a system-orientated preventive approach to ethical issues in health care. This approach is similar to that which has
been adopted to help reduce the incidence and impact of preventable clinical adverse events in hospitals. Highlighting what has been termed the ‘ethics-quality linkage’ (Nelson et al 2010), proponents contend that by stakeholders collaboratively developing protocols that include ‘a clear system for determining the appropriate management of common ethical conflicts that are grounded in ethical principles, patient safety goals and adherence to the organisation’s mission’ (Nelson 2008), staff members will be assisted to ‘do the right thing’. They go on to suggest that anticipating and preventing ethics conflicts in this way will be more effective than the conventional ‘reactive approach’ which has long proven to be unsatisfactory because of focusing on complex and catastrophic isolated clinical ethics cases that, once manifest, are near impossible to resolve.
To progress a preventive approach to ethical conflict in health care a four step process encompassing the following has been recommended: 1. identifying recurring ethical issues (eg. limiting patient rights, DNR directives, informed consent issues, confidentiality and privacy, patient safety concerns, and others); 2. studying the issues; 3. d eveloping an ethical practice protocol; and 4. propagating the protocol into the culture of the organisation (Nelson 2008). Based on their knowledge and experience of the health care system, as well as their codified obligations as ethical professionals, nurses have an obvious and important role to play in establishing and advancing this four-step process.
The patient safety movement is principally concerned with reducing the incidence and impact of preventable clinical adverse events and promoting patient safety in health care. Even so, there are valuable lessons that can be learned and applied to improving what might be termed here the moral safety of health care (Johnstone & Hutchinson). By developing mechanisms for reducing the incidence and impact of ‘preventable moral harms’ in clinical settings and fostering a ‘culture of moral safety’, the health care environment can emerge as a safe place that is free of preventable threat to the significant moral interests of those
who frequent it. Accepting this, however, there is one notable point of difference that warrants acknowledgement: the role of ‘appropriate’ disagreement on ethical issues in the workplace. Disagreement on ethical issues in health care contexts are not only inevitable, but ought to be encouraged as a means of ‘quality assuring’ the ethical decisions that are made and the processes for making them. Moreover, it is important to understand that moral disagreements in practice need not be the cause of distress. This is because consideration of other points-of-view can enrich people’s moral thinking and experience, can help them to think about old problems in new ways, and can also help them to identify and respond to previously unrecognised problems. This process must, however, remain discretionary and not inadvertently encapsulate rules that could see ethical issues take on a legal form (a risk also with national consensus statements involving ethical issues). If this were to happen, the whole intention and purpose of a preventive ethics approach would be seriously undermined.
Forrow, L., Arnold, R., & Parker L. 1993. Preventive ethics: expanding the horizons of clinical ethics. Journal of Clinical Ethics, 4(4):287-294. Johnstone, M-J & Hutchinson, A. In press. Moral distress in nursing – time to abandon a flawed nursing construct? Nursing Ethics, doi:10.1177/0969733013505312 Nelson, W., Gardent, P, Shulman, E. & Splaine, M. 2010. Preventing ethics conflicts and improving health care quality through system redesign. Quality and Safety in Health Care, 19: 526-530. Nelson, W., Neily, J., Mills, P., & Weeks, W. 2008. Collaboration of ethics and patient safety programs: opportunities to promote quality care. HEC Forum, 20(1): 15-27.
Megan-Jane Johnstone is Professor of Nursing in the School of Nursing and Midwifery at Deakin University In Victoria. Professor Johnstone has extensive interest and expertise in the area of professional ethics in nursing. PAGE 33 June 2014 Volume 21, No. 11.
Clinical Update Kenneth Murray, Denise Cummins and Kevin Bloom
Developing a protocol for people living with HIV entering residential aged care facilities Primary argument:
Advances in HIV antiretroviral therapy have led to an increase in survival for people living with HIV (PLWH) in Australia. Consequently there are more PLWH who are ageing and needing higher levels of care including residential aged care support. HIV community teams’ current practice supporting clients through transition to residential aged care facilities (RACFs) is inconsistent, with consequent variable outcomes for clients and RACFs. Working in partnership with the client and RACFs, a new protocol (Aged Care Transition Plan) was developed to guide clinical practice and was piloted in collaboration with community HIV teams, clients and local RACFs.
Advances in HIV treatment have reduced morbidity and mortality amongst PLWH in Australia. HIV is now seen as a chronic and manageable medical condition (Gallant, 2000). This is mainly due to the emergence of Highly Active Antiretroviral Therapy (HAART), an effective daily medication for treating the progression of HIV disease (Gallant, 2000). Jansson and Wilson’s (2012) projection of the population of PLWH in Australia shows a shift whereby the proportion of PLWH aged greater than 55 years are increasing at a greater rate. It is estimated that the proportion of PLWH aged over 55 years will increase from 25.3% (in 2010) to 44.2% by 2020. It is therefore expected that there will be greater numbers of PLWH requiring physical and complex clinical care including management of co-morbidities, chronic diseases, interactions between HAART and other medications, as well as possible complications associated with long-term HIV infection and long term use of HAART. Some of these people will likely need residential care.
Keywords: Residential Aged Care Facility (RACF) Human Immunodeficiency Virus (HIV) Transitional Care Plan, Highly Active Antiretroviral Therapy (HAART)
Objective: Provide a continuum of care for HIV positive people being admitted to residential aged care facilities for either short term respite, or more permanent placement.
Setting: Community based HIV primary care services in inner city Sydney NSW.
Subjects: PLWH who are being admitted into residential aged care facilities.
Conclusion: Introduction of the new model provides a standard of care that will improve partnership between PLWH entering aged care, community HIV teams and RACFs, leading to better health outcomes including social and cultural concerns, linkage with HIV medical and social support services and streamlined access to antiretroviral medication.
Dementia in the general Australian population is a rapidly growing source of disease burden and is the leading cause of disability in Australians aged 65 and older. In 2012 the Australian Health Ministers recognised dementia as the ninth National Health Priority area (Department of Health and Ageing). According to Buchanan, et. al., (2001) improved life expectancy for PLWH suggests that the prevalence of HIV Associated Neurocognitive Disorder (HAND) will increase in the future. HIV related neurological disorders in their milder forms (memory problems and slowness, difficulties in concentration, planning, multitasking and coordination) represent substantial personal, societal and economic burdens, with some studies suggesting up to 52% of participants being affected (Heaton et al., 2010; Skinner et al, 2009). It has been noted that PLWH may experience accelerated ageing leading to dementia prevalence occurring in this population at a younger age compared to the general community. This adds to the need for higher level clinical care for PLWH who may be living longer with dementia. According to Cystique, et. al., (2011) the annual cost for care in Australia related to HIV associated dementia will increase from approximately $29 million in 2009 to $53
million in 2030. RACFs are part of the continuum of long-term and short-term care needed for PLWH (Kearney et al, 2010).
Issue: There will be an increased need for collaboration between RACF and specialist community HIV teams as RACFs see increasing numbers of PLWH entering their facilities. Although RACFs are experienced in dealing with ageing and chronic co-morbidities, PLWH represent a relatively novel cohort of residents who have particular needs and ongoing supports specifically related to their HIV. Specialist HIV community teams are involved in referrals to RACFs and assisting clients with the transition to their changed circumstances. The process currently is ad hoc and dependant on individual clinicians. Because there is no standardised process, clinicians are left ‘reinventing the wheel’ for each new admission to aged care.
Risks to health in the target group: The cohort of HIV positive aged care residents will present added challenges in the form of particular issues related to social and cultural concerns, specialised HIV medical and social support services, access to HAART medication and perceptions of infection control. Reduced adherence to HAART increases the risk of resistant virus (Wahl and Nowak, 2000). An adherence rate of 95% or higher is needed for HAART to maintain the person’s health and maintain optimal viral suppression, and those with less than 95% may have a shorter survival rate (Paterson, et al., 2000). Medication adherence is a particular risk for PLWH with cognitive impairment, as individuals with cognitive impairment have been shown to be less adherent to medication regimes (Robertson-Papp et al, 2010). As the HIV population ages, comorbidities rise, and increased risk of drug-drug interactions occurs. Renal function declines with age and sometimes independently associated with HIV infection. As pharmacologic clearance slows and absorption becomes less consistent, irregular drug levels, toxicities and mortality can occur (Vance, et al, 2011). Regular monitoring by HIV trained clinicians can ensure known potential issues are monitored and addressed.
Clinical Update PLWH are at greater risk of stigma and discrimination based on HIV status and/or sexuality (Grierson, et.al, 2013). Real or perceived discrimination may impact on the individual’s decisions about care and their experience within RACF. In a study by Cummins and Trotter (2008), 61% of participants were apprehensive about future placement into an RACF, 54% of respondents were concerned about lack of HIV knowledge of staff; 42% lack of experience of caring for PLWH and 48% worried about HIV related discrimination. Those respondents who identified as gay were anxious that aged care facilities were not gay friendly (p=0.003).
Opportunities to address: Specialist HIV Community Teams’ case management model involves assessment and collaboration with clients, carers and services including (but not limited to) PLWH’s social networks, hospital and medical care, formal and informal caregivers, community organisations, socioeconomic and legal issues. The collaborative relationship with the client leads to a knowledge of clients’ strengths and values as well as barriers to achieving health and wellbeing. By drawing on this therapeutic relationship, case managers are in a unique position to involve clients and services in the development of an individualised transition plan, enhancing communication with RACFs. This assists with strengthening the continuum of care between the home, hospital and RACFs. There was no standardised process or care plan from the HIV community services to guide this process, potentially leading to incomplete information and inadequate handover, which could compromise the client journey.
Project outline: A working group was established to focus on the issue in partnership with RACFs. A needs analysis involving staff from local RACFs revealed that a document outlining relevant information including social demographics, legal status (eg. Advanced Care directive, Guardianship), medical information, and a list of services involved with the client would be valuable. Comments on and review of the initial transition care plan were positive indicating that this tool would be useful to optimise the continuum of care for the PLWH. The working group developed a protocol and tool (Aged Care Transition Plan) to guide clinical practice related to the transition process. The protocol assists clinicians to identify factors specific to the individual
to be incorporated into the plan. The protocol also highlights any need for education to RACF staff regarding such issues as: HIV transmission, illness progression, treatments, perception of infection control issues, confidentiality, privacy and stigma. HIV community teams are responsible for providing and/or organising education. The protocol and tool will be evaluated over the next twelve months as they are utilised for transition of care. Evaluation will include staff of RACFs, specialist HIV community teams and PLWH being admitted to RACFs.
Medication access: HAART are supplied under the Pharmaceutical Benefits Scheme Highly Specialised Drugs Program, and for this reason are only able to be prescribed by specially credentialed GP’s and medical specialists. HAART can only be dispensed through hospital pharmacies, or, in NSW, through the Enhanced Medication Access (EMA) Scheme administered by the Albion Centre.
PLWH. Under the scheme up to four months supply of HAART can be mailed to a community pharmacy nominated by the RACF for no additional charge. The community teams enroll new residents into the EMA to assist RACFs to maintain medication adherence throughout the residents’ stay.
Results: The protocol and tool assisted Specialist HIV Community Teams by providing a standard process to guide transitioning clients to RACFs. It highlighted the need to focus on other issues such as medication access and educational requirements. The protocol and tool are currently being used by multiple HIV Community Teams. The working group has developed an evaluation plan, which requires the group to meet in late 2014 to review the protocol, tool and outcomes. A protocol was developed to guide the transition of care process. (see Table 1)
The restricted access to S100 medications is challenging for RACFs. The EMA Scheme is designed to improve access to HAART for
Table 1 Aged Care Transition Project Protocol Preparatory phase 1. ACAT assessment completed 2. Identification of aged care facility 3. Meet with client, carer’s and/or guardian to discuss ongoing support needs 4. Negotiation of HIV and other health care treatment with the identified nursing home I.
Identification of health care services
II. Identification of NGOs and other services III. Formulation of timeframe for transfer to nursing home IV. Explore potential issues with care/support within the nursing home 5. Liaison with health care professionals, NGOs and other support services I. Collation of reports, medical history, discharge summaries, other relevant information/documentation II. Coordination of appointments III. Negotiation of roles 6. Timeframe of service support from HIV community teams. I. review and develop exit plan with client, carer’s and/or guardian Implementation Phase 7. Completion of Community HIV Aged Care and Transition Project transition plan 8. Implementation of exit strategies for HIV community services 9. Completion of care 10. Evaluation of transition to aged care PAGE 35 June 2014 Volume 21, No. 11.
Clinical Update The Transition tool (Table 2) was developed to provide documentation of pertinent clinical and social information regarding the person, while guiding the exit strategy of Specialist HIV Community Teams in partnership with the client and the RACF. It will also provide contact details of services which will be maintained such as NGOs, HIV prescriber and other support services. Table 2
Community Aged Care Transition Plan Name:
HIV Case Manager:
Aged Care Facility:
Interpreter Needed: Y N
Background information (Age, social history, cultural considerations, previous accommodation)
Legal Status (circle which applies) Guardianship Trustee Advanced Care directive
Power of Attorney
Copies attached p
Medical Information attached: GP/Hospital Specialist Summary p
Upcoming appointments: p
Medication list provided: Y N
BGF funding for ARV: Y N
EMA set up: Y N
Role GP Medical Specialist
HIV Case Management Exit Plan: (outlines tasks and timeframe to complete community case management and transition to aged care management)
Date: Community Plan for Aged Care Transition
Conclusion: Early feedback has indicated that the protocol and tool have strengthened the continuum of care for PLWH being admitted to RACFs. The protocol is a guide for community HIV staff to acquire and collate information needed for each individual. It provides useful communication between RACFs, PLWHs and community services to deliver a seamless transition to RACF care.
Recommendations: This protocol and tool is a beneficial guide to improve outcomes for PLWH entering RACFs. They can be used whenever PLWH is moving into a RACF.
Buchanan, R. J., Wang, S., Huang, C.,(2001). Analyses of Nursing Home Residents with HIV and Dementia using the Minimum data set. Journal of Acquired Immune Deficiency Syndromes. (26):246-255. PAGE 36
Jansson, J., Wilson, D. P. Projected demographic profile of people living with HIV in Australia: planning for an older generation. PLoS One.,(2012);7(8):e38334. doi: 10.1371/journal. pone.0038334. Kearney, F., Moore, A. R., Donegan, C. F., Lambert, J., (2010) The ageing of HIV: implications for geriatric medicine. Age and Ageing 39 (5): 536-541 doi:10.1093/ageing/afq083 Paterson, D. L., Swindells, S., Mohr J, Brester, M., Vergis, E.N., Squier, C, Wagener, M. M., & Singh, N.,(2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine. 133(1):21-30. Robinson-Papp, J., Elliott, K. J., & Simpson, D. M.,(2009). HIV-related neurocognitive impairment in the HAART era. Current HIV/AIDS Reports. 6(3):146-52. Skinner, S., Adewale, A. J., DeBlock, L., Gill, M.J., & Power, C.,(2009). Neurocognitive screening tools in HIV/AIDS: comparative performance among patients exposed to antiretroviral therapy. British HIV association HIV Medicine 10:246-252. Department of Health and Ageing www.health. gov.au/internet/main/publishing.nsf/content/dementia (accessed 23 January 2014) Vance, D.E., McGuinness, T., Musgrove, K., Orel, N., Fazeli, P. L.,(2011). Clinical Interventions in Aging (6):181–192. DOI: http://dx.doi.org/10.2147/ CIA.S14726
Exit Date: Completed By:
C., Jernigan, T. L., Wong, J., Grant, I.,(2010). CHARTER Group. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology. 75(23):208796. doi: 10.1212/WNL.0b013e318200d727
Cummins, D., Trotter, G., (2008) Ageing and HIV disease – a client’s perspective. Australian Journal of Advanced Nursing. 25:3, 58 – 64. Cystique, L. A., Bain, M.P., Brew, B.J., Murray, J. M.,(2011). The burden of HIV associated neurocognitive impairment in Australia and its estimates for the future. Sexual Health. 8:541-550. Gallant, J.,(2000). Strategies for Long-term Success in the Treatment of HIV Infection The Journal of the American Medical Association. 283(10):1329-1334. Grierson, J., Pitts, M., & Koelmeyer, R., (2013) HIV Futures Seven: The Health and Wellbeing of HIV Positive People in Australia, monograph series number 88, The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia. Heaton, R. K., Clifford, D. B., Franklin, D. R Jr., Woods, S. P., Ake, C., Vaida, F., Ellis, R. J., Letendre, S. L., Marcotte, TD., Atkinson, J. H., Rivera-Mindt, M., Vigil, OR., Taylor, MJ., Collier, A. C., Marra, C. M., Gelman, B. B., McArthur, J. C., Morgello, S., Simpson, D. M., McCutchan, J. A., Abramson, I., Gamst, A., Fennema-Notestine,
Wahl, L. M., & Nowak, M.A.,(2000). Adherence and drug resistance: predictions for therapy outcome. Proceedings of the Royal Society of London – Series B: Biological Sciences. (267):835-843. World Health Organization (WHO). Adherence to long term therapies – evidence for action. 2003. www.who.int/chp/knowledge/publications/adherence_full_report.pdf.
Kenneth Murray is a clinical nurse consultant with the HIV Testing and Liaison Project, HIV and Related Programmes Unit, South Eastern Sydney Local Health District Denise Cummins is a clinical nurse consultant in HIV Disease, Sydney District Nursing, Sydney Local Health District Kevin Bloom is a senior social worker, Positive Central, Sydney Local Health District
Research Getting hospital boards on board
‘Bad’ cholesterol link to cancer spread Australian researchers have discovered ‘bad’ cholesterol helps cancer spread throughout the body. The University of Sydney research found ‘bad’ cholesterol (Low Density Lipoprotein, or LDL) regulates the machinery that controls cell migration, a major finding in the search to explain why cancer spreads throughout the body.
Positive patient experience is a key part of high quality health care and goes beyond responsibility of frontline medical and nursing staff, according to a University of Melbourne study. Researchers for the study found safeguards to improve patient experiences was not the sole responsibility of doctors and nurses but is a core governance responsibility for hospital leaders, including the board. Melbourne School of Population and Global Health’s Dr Marie Bismark said evidence was building about the link between effective partnerships with health care consumers and high quality health care. “We’re seeing a real change in attitudes in the health sector. Patients are becoming more engaged with their own health care decisions and more willing to question the way in which services are provided.” Dr Bismark found that while some health services boards in Victoria were embracing the change, others were more reluctant to
move away from traditional models of care. “Our interviews with health services boards in Victoria showed that some boards are highly active in improving patient experiences. It’s at the heart of everything they do. But other boards still don’t see patient experience as a priority – they are more focussed on financial issues, are not sure how to engage with consumers effectively, or see it as a ‘tick the box’ exercise with little real impact.” Study co-author Health Issues Centre’s Susan Biggar said Australia needed to learn from the experiences that occurred at MidStaffordshire Trust in the UK. “When hospital boards don’t listen to the concerns of patients and their families, lives are put at risk. It’s time for boards to put their hearts, as well as their minds, into working with consumers to improve patient experience.”
Senior researcher Associate Professor Thomas Grewal said one of the things that made cancer so difficult to treat was the fact that it can spread around the body. “Most of the cells in our bodies stick to neighbouring cells through the help of ‘Velco-like’ molecules on their surface known as integrins. Unfortunately, integrins also help cancer cells that may have broken away from a cancerous tumour to take root elsewhere in the body.” The study found that ‘bad’ (LDL) cholesterol controls the trafficking of tiny vessels, which also contain these integrins, and this has huge effects on the ability of cancer cells to move and spread throughout the body. “Our research found that having high amounts of ‘bad’ cholesterol seem to help the integrins in cancer cells to move and spread,” said Associate Professor Grewal. “In contrast, we found the high levels of ‘good’ (HDL) cholesterol keeps integrins inside cells and may therefore protect against cancer cell spread.”
New DNA blood test for bowel cancer A new blood test for bowel cancer based on two genes that “leak” into the blood can detect 65% of bowel cancer cases, with the detection rate increasing to 73% for cancers that are stage two or higher, an Australian study has found.
The results were based on blood specimens collected at an Australian and Dutch hospital from more than 2,000 volunteers
who were scheduled for colonoscopy or for bowel surgery.
which at the moment are primarily based around faecal tests.”
Study lead Flinders University’s Professor Graeme Young said the test could be a candidate for population screening in the future and its sensitivity for cancer justifies prospective evaluation in a large screening population. “A blood test is likely to overcome some of the barriers to screening with faecal tests. It might prove to be acceptable to those failing to participate in screening using established methods,
If the test becomes available in the future, Professor Young said the message would need to be that the faecal test is the best place to start for people who are due for screening. “Then the plasma test would be for those people who can’t or won’t be screened with a faecal test.” Professor Young presented the research at the Digestive Diseases Week conference held in Chicago last month. PAGE 37 June 2014 Volume 21, No. 11.
Kieran and Rasa PAGE 38
Mental Health Kieran’s story By Rasa Kabaila I became Kieran’s case manager in 2013 after he was referred to our community health team for support; he had been diagnosed with schizophrenia and epilepsy. Kieran is the same age as me and I feel in many ways we can relate to each other as we are both in a similar point in our life, the constantly changing, exciting and scary 20’s. Furthermore, Kieran and I both enjoy artistic endeavours, although Kieran’s work is his profession and mine are hobbies. I dance and enjoy drawing and craft and Kieran is a talented artist and musician. In writing about his illness Kieran states: “It is still really hard for me to deal with this illness; especially when there are no signs of when I’m getting sick, and how quickly things turn from bad to much
“Kieran and I both enjoy artistic endeavours, although Kieran’s work is his profession and mine are hobbies. I dance and enjoy drawing and craft and Kieran is a talented artist and musician.” worse ie. when I was last hospitalised, I started off with really bad paranoia, and was very delusional. But things turned worse in about a week or two, as I started to have visual and auditory hallucinations, etc. Recovering from an episode like this takes lots of time and usually means months of time spent in the wards, and the more they occur, the more they are likely to recur and even worsen. After being in and out of psychiatric wards for the last several years, I now accept this and understand it may stay like this, but I keep a positive outlook on it all hoping that the psychotic episodes will eventually diminish and my quality of life will stay consistently better.” Fortunately, Kieran’s artwork has really been a motivator for him to move forward with his life. His art is beautiful, colourful, imaginative and precise. Kieran sells his artwork on canvas and owns a clothing label named ‘I Heart Threads’. He produces his designs by illustrating on drawing tablets and does further editing in computer programs. The blank garments are sourced
stARTalking from a company in Sydney. The designs and garments are then sent to a printing factory based in Sydney, where they are printed via Direct To Garment (DTG). Kieran sells online in Melbourne and has since had some interests in selling his work voiced from all the way over in Japan.
By Louise Ward and Sinead Barry
Finding out about two art competitions, the Mindscapes Festival and RAW: natural born artists, I encouraged Kieran to enter, which he did.
It requires attention to current health care issues and treatment initiatives. It involves motivating undergraduate nursing students to actively engage in promoting a recovery process of client engagement through effective communication, and the development of strong connections within the community.
The Mindscapes Festival offers mental health consumers opportunities to express their artistic abilities, to support their own recovery, help with social inclusion and reduce stigma. Kieran won the Mindscapes Festival Arts Competition. This was very exciting for him and it made me feel very happy that I was able to contribute in some way. RAW: natural born artists, is an international independent arts organisation that hand-selects and spotlights independent creatives in visual art, film, fashion, music, hair and makeup artistry, photography, models and performing art. Kieran entered this competition and was a finalist. Kieran has also exhibited his work recently in Melbourne and Canberra - the future is looking bright. He is now hoping to be able to stay in recovery while looking at the possibility of gradually and safely reducing his anti-psychotic medication with professional help and guidance. I am so proud of Kieran’s hard efforts to stay in recovery. He has had great support from his family, girlfriend and friends, however it’s Keiran that deserves the greatest plaudits. This story is an example that mental illness does not have to be a curse and that people with mental health issues can live great lives. You can view or purchase Kieran’s artwork on the following website www.iheartthreads.com.au/
Undergraduate mental health nursing education requires innovative and engaging student learning opportunities.
To meet these objectives La Trobe University, School of Nursing and Midwifery developed an art project called stARTalking. The project was facilitated during a clinical placement at Corpus Christi Community (CCC) in Melbourne, 2013. stARTalking was a program that used an interdisciplinary approach to undergraduate mental health education, involving La Trobe University art therapy students, La Trobe University nursing students, CCC clients, CCC staff and academics. The process of art making provided a diversional activity to support group sharing and an opportunity for students to develop their communication skills, potentially gaining a greater understanding of the clients they were caring for. The students were able to establish meaningful interaction and develop therapeutic relationships in which to provide care. The artwork created was then exhibited at La Trobe University Art space. stARTalking, as the title implies, allowed creative works and/or the art to speak for the client and the student. It speaks of partnership and collaboration and community engagement as a way to support undergraduate mental health nursing education and client outcomes. Dr Louise Ward is senior mental health lecturer and Sinead Barry is a lecturer in Nursing. Both are located in the School of Nursing and Midwifery at La Trobe University, Victoria.
Rasa Kabaila is a level two registered nurse and clinical manager
PAGE 39 June 2014 Volume 21, No. 11.
Focus A mental health issue that does not discriminate
Dr Susan Koch talks about dementia research to radio host Michelle Martin on Singapore radio 938LIVE in April
By Fleur Duane When RDNS Institute Director Dr Susan Koch was a guest on Singapore radio 938 it became clear from the feedback and general conversations that dementia is becoming a mental health issue of increasing concern around the world. Dr Koch was in Singapore for the Ageing Asia Investment Forum where she led a dementia workshop for international delegates from more than 20 countries. Here in Australia we are already facing the challenge of a rapidly escalating prevalence of dementia (Access Economics, 2010) with the condition now featuring as one of the leading causes of death in the country (Australian Bureau of Statistics, 2012). Many identify dementia as stemming from Alzheimerâ€™s disease; however there are many causes of cognitive decline. A myriad of factors may exist or co-exist making the determination the underlying diagnosis a challenge to health professionals (Tripathi & Vibha, 2009). Depression, delirium, medicines, alcohol, malnutrition or metabolic disorders are just PAGE 40
a few examples of such conditions that may affect the mental function of an individual and further, may occur in people with dementia (Tripathi & Vibha, 2009). Community nurses, such as those with RDNS are well placed to identify and screen people with cognitive changes. In responding to this growing need, RDNS with a grant from The JO & JR Wicking Trust developed the Dementia Model of Care which includes an electronic assessment tool to examine issues further (Nunn, While & Sims, 2009). The RDNS Institute continued this work with further generous funding from The Ian Potter Foundation and the Lord Mayorâ€™s Charitable Foundation, to examine how specialist dementia nurses may support the assessment process and contribute to timely diagnosis of concerns. An aged care nurse practitioner working in the community setting is perhaps the final piece of the clinical response required in detecting, screening and managing dementia and other conditions through the added capacity to order diagnostic tests and prescribe medication thus reducing the burden on already exhausted medical resources. Currently RDNS has its first Nurse Practitioner in Aged Care, due to complete study at the end of this year,
who has both the passion and drive to optimise outcomes of the aged population, particularly those with dementia. Based at the Altona RDNS site I believe the role offers infinite possibilities to improve outcomes for clients, and I am hoping to inspire more people into working with those in community dementia nursing.
Australian Bureau of Statistics (2008) Causes of Death, Australia 2012, Available from www.abs. gov.au/ausstats/abs@.nsf/Lookup/3303.0main+f eatures100012012) accessed 9/04/2014 Access Economics (2010) Caring places: planning for aged care and dementia 2010-2050, Available from: www.fightdementia.org.au/ common/files/NAT/20100700_Nat_AE_Vol1CarePlaces2010-2050.pdf accessed (9/04/2014) Nunn, R., While, C. & While, N. (2009), Out of the Shadows: The Development of a Best Practice Model of Care for People Living with Dementia, Royal District Nursing Service, Melbourne Tripanthi, M. & Vibha, D.(2009) Reversible dementias, Indian Journal of Psychiatry, S52-S55
Fleur Duane, MN, RDNS clinical nurse consultant Dementia with the RDNS
Mental Health Adopting the Team Leader Model of student supervision into the acute mental health setting By Karen Heslop, Karen Curtis and Amaelea Oh The ‘Team Leader Model’ (TLM) of student supervision takes a team approach to supporting staff and supervising student and graduate nurses on their clinical placements (Russell, Hobson, & Watts, 2011). This model allows student nurses on short clinical placements to participate in, rather than observe, direct patient care under the direct supervision of a registered nurse. A research project was undertaken to evaluate whether the adoption of the TLM in an acute mental health provided: i) better educational outcomes for student and graduate nurses; ii) increased likelihood that nurses from undergraduate nursing programs choose to practice in mental health after registration; iii) improved skills, knowledge and satisfaction for registered nursing staff who supervise student and graduate nurses, than the traditional ‘preceptor model’.
Method: The study design was a ‘before and after intervention study’; the intervention being the introduction of the TLM. All consenting student nurses completed two questionnaires, the Clinical Learning Environment Scale (Dunn and Burnett, 1995) and the Mental Health Nursing Clinical Confidence Scale. They also participated in a focus group to explore their experiences of their clinical placement. Registered nurses completed the preceptor questionnaire (Mowday, Steers & Porter, 1979) and participated in focus groups to investigate their experiences of supervising student and graduate nurses. Seventeen registered nurses, 53 student nurses from four universities and two graduate nurses took part in the study. Results: Qualitative and quantitative data revealed improved learning outcomes for student nurses in terms of skills and knowledge. Student nurses felt more confident managing clients with a mental illness and felt that they were part of the mental health nursing team. Many reported a desire to practice in the mental health area once registered. Registered
nurses reported supervising students using the TLM provided opportunities to teach, improved their knowledge, gave them an understanding of contemporary practices and increased their confidence to provide supervision to students.
Bell, A., Horsfall, J & Goddin,W., (1998) The mental health nursing clinical confidence scale: A tool for measuring undergraduate learning on mental health clinical placements. Australian and New Zealand Journal of Mental Health Nursing, 7(4) 184-190. Dunn, SV. & Burnett P., (1995) The development of a clinical learning environment scale. Journal of Advanced Nursing 22(6) 1166-1173. Mowday R., Steers R. & Porter L., (1979) The measurement of organizational commitment. Journal of Vocational Commitment 14, 224-227 Russell, K., Hobson, A., & Watts, R. (2011). The Team Leader Model: An Alternative to Preceptorship. Australian Journal of Advanced Nursing 28(3), 5-13.
Karen Heslop is clinical nurse consultant, Practice Improvement (Mental Health); Karen Curtis is acting nursing director of Mental Health and Amaelea Oh is a clinical nurse. All are in the Department of Psychiatry at the Royal Perth Hospital in WA
Positive changes in mental health By Anni Fordham
Fremantle Hospital Mental Health Services (FHMHS) staff have been hard at work implementing a range of positive changes aimed at improving the experience for inpatients and outpatients dealing with mental health conditions. Nursing staff have played a crucial role in the improvements. FHMHS medical co-director Dr Ajay Velayudhan said that in addition to continued efforts to deliver high quality care, there had been a heavy focus on standardising and improving clinical documentation – meaning clinical decisions were being documented more thoroughly than ever before. “We are standardising data collection methods to ensure information is recorded consistently and thoroughly.”
Clinicians are partnering with consumers, carers and community groups to ensure care is provided in a collaborative and coordinated way – positioning consumers as active participants in their own recovery.
Other new initiatives are looking at ways to help consumers to make their way back to active community life by helping them find employment, accommodation and links to other support services.
“A consumer advisory group (CAG) has been established, with the aim of contributing to all levels of strategic planning, policy review and information sharing – including contributing to aspects of the patient journey from initial admission to discharge and reintegration into the community,” Dr Velayudhan said.
Peer support workers are engaging with patients in the community to support their recovery journeys in conjunction with the treating team.
“The CAG meets regularly to discuss and review policies involving consumers and CAG members participate in other working parties where relevant.” A ‘Care Coordination’ framework has been introduced to support collaborative personcentred care, carer involvement and partnership in recovery-focused care planning.
Dr Velayudhan said FHMHS was committed to partnering with consumers to improve its services on an ongoing basis. “We will continue to evaluate these initiatives and listen to our consumers and their families to ensure we are providing the highest possible standard of care.” Anni Fordham is the public relations officer at Fremantle Hospital and Health Service in WA
PAGE 41 June 2014 Volume 21, No. 11.
Are You a Nurse and a Skier/Boarder?
JOIN SONS NOW!
www.sons.net.au Do You Wish to Enrich Your Medical Knowledge?
BRUSH UP ON YOUR MEDICINE (AND YOUR SKIING)!
SOCIETY OF NEUROMUSCULAR SCIENCES INC. 40 ANNUAL CONFERENCE IN THREDBO TH
The S.O.N.S (Society of Neuromuscular Sciences) 40th Annual Conference in Thredbo is to be held at the Thredbo Alpine Hotel from Monday 11th to Friday 15th August 2014 and boasts a very good lecture and social programme. A variety of topics from all areas of Medicine will be presented and these will appeal to Specialists, Registrars, RMO’s, General Practitioners and Allied Health Professionals.
New members are welcome and the registration fee is quite modest with special discounted rates for Registrars and RMO’s. Medical students are free to attend lectures. A special gala dinner is planned to celebrate our 40th Anniversary at Thredbo and past, present and new members are welcome.
OUM’s innovative teaching style is fantastic and exciting. Truly foreword thinking, OUM allows the student to benefit from both local and international resources. Brandy Wehinger, RN OUM Class of 2015
FOR MEMBERSHIP AND REGISTRATION INFORMATION CONTACT: THE SECRETARY 441 Bangerang Rd, Echuca Village, VIC 3564 Phone: 03 54807206 Fax: 03 54826724 Email: s.o.n.s @bigpond.com
RN to MBBS
Make the dream of becoming a doctor a reality, earn your MBBS at Oceania University of Medicine. n Attractive fee structure for our Graduate Entry Program. n Over 150 students currently enrolled and over 50 graduates in Australia, New Zealand, Samoa and USA. n Home-based Pre-Clinical Study under top international medical school scholars, using world leading Pre-Clinical, 24/7 online delivery techniques. n Clinical Rotations can be performed locally, Interstate or Internationally. n Receive personalised attention from your own Academic Advisor. n OUM Graduates are eligible to sit for the AMC exam or NZREX.
Applications are now open for courses beginning in January and July - No age restrictions
OCEANIA UNIVERSITY OF MEDICINE INTERNATIONALLY ACCREDITED For more information visit www.RNtoMBBS.org or 1300 665 343
Forthcoming conferences in 2014 ...
Melbourne, August 20 & 21
Melbourne, October 30 & 31
Facilities Management in Aged Care Conference Melbourne, October 30 & 31
Melbourne, October 30 & 31
Each conference has exceptional 2 for 1 Early Bird Registration Special All enquiries re exhibiting or attending, contact: Wayne Woff, Manager, Total Aged Services P: 03 9571 5606 / 0422 484 209 E: email@example.com www.totalagedservices.com.au
Mental Health New ways to enhance mental health nursing: collaboration between academy and practice being more resistant to erosion than factual knowledge. The locked boxes are a means to prevent the curriculum decay that has occurred widely since comprehensive training commenced (Warelow & Edward, 2009). Within these boxes content and assessment items cannot be altered without going through a school board level review. Additionally, though placing mental health within the contexts of physical health conditions, students are conditioned to see mental ill health within the same framework of values.
“Within regional Australia the need for such collaboration is arguably amplified through having fewer resources in contrast to urban settings. Southern Cross University (SCU) in partnership with regional health services developed a programmatic raft of responses to strengthen MHN preparation.” Educators and graduates participating in the Transition to Mental Health Nursing Programme
By John Hurley, Iain Graham, Steve Van Vorst and Andrew Cashin Despite the efforts of mental health nurse (MHN) leaders and the Australian College of Mental Health Nursing (ACMHN) the current state of mental health nursing remains fragile. After a social generation of having undergraduate mental health nursing taught within a comprehensive framework, repetitive studies identify inadequate preparation and recruitment difficulties (Evangelou, 2010; Happell et al. 2011). Additionally, as new graduates embed themselves into general nursing practice, there is a further erosion of mental health knowledge and capability. The importance of this latter point in providing safe mental health nursing care is heightened when many general RNs are placed onto mental health units to cover staff shortages (Happell, 2014). Post graduate workforce preparation has a low uptake (Health Workforce Australia, 2013) and even where under-
taken courses are predominantly online and theoretical, rather than focusing on developing clinical skills (ACMHN, 2011). Challengingly, these issues occur within a context of a growing mental health needs across the community (Australian Bureau of Statistics, 2008). Indeed, such are the challenges that nursing academy and practice need to be developing innovative levels of collaboration. Within regional Australia the need for such collaboration is arguably amplified through having fewer resources in contrast to urban settings. Southern Cross University (SCU) in partnership with regional health services developed a programmatic raft of responses to strengthen MHN preparation. Undergraduate preparation has been reconfigured with mental health taught within ‘locked boxes’ throughout the majority of units. The content of the ‘locked boxes’ are developed and taught by mental health academics and have a strong emphasis toward developing positive values toward consumers, with values
A ‘transition to practice’ program has been running for the last two years where first year and second year RN positions are recruited and are then typically rotated through a range of mental health settings. Work based education blocks are provided with a focus on clinical capabilities, as well as evidenced based knowledge. These education sessions culminate in written assignments requiring equal academic requirements as formal SCU assessments and are hence recognised with two units of Accreditation of Prior and Experiential Learning (APEL). Senior academic staff are supported to be clinically active, adding currency and relevancy to their teaching and learning. Additionally, research projects identified within those clinical roles frequently include staff from services, offering them the opportunity to enhance their research skills and build research capacity. Examples include preparing students for placement (Hurley et al.2012) and stigma reduction (Hurley et al. In press). Working in partnership across the academy and services and with consumers, the specialised nature of MHN practice PAGE 43 June 2014 Volume 21, No. 11.
Asthma Educator’s Course
This 3 day course covers the latest advances in asthma care & provides participants with the knowledge & skills to work effectively with people with asthma to improve their health outcomes. (NB: Optional 4th day on education & presentation skills.)
Keeping the body in mind
16 - 18 July 12 - 14 November Respiratory Course This two part, 5 day course is for participants wanting to update & increase their skills & theoretical knowledge in the area of respiratory care & holistic management of the person with respiratory illness. 3 – 5 September / 15 – 16 October Theory & Practice of Non Invasive Ventilation – Bi-level & CPAP Management This comprehensive & practical day course is for participants wanting an increased understanding of & skills in the management of NIV, Bi-level & CPAP from the ICU to the community carer. 13 June Managing COPD This 2 day program is for participants wanting to improve their understanding of & update their knowledge in the current treatment & management of COPD. 23 – 24 October Smoking Cessation Course This 2 day, evidence-based course aims to give participants the knowledge & skills to treat & manage nicotine dependency to help people addicted to smoking to quit. 24 - 25 July 20 - 21 November For further information about these & other courses contact the: Lung Health Promotion Centre at The Alfred Phone: (03) 9076 2382 E-mail: firstname.lastname@example.org
www.lunghealth.org PAGE 44
can be realised and articulated. The utilisation of theories drawn from human behaviour and human development provide opportunity to see the consumer as a developing person, not a medical diagnosis. This requires a strong partnership, common philosophy and clarification of values and purpose between service and the academy and the practitioner.
Australian Bureau of Statistics. (200). National Survey of Mental Health and Wellbeing. Available: www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0 Australian College of Mental Health Nursing. (2011). Scan of Postgraduate Mental Health Nursing Programs in Australia 2011. Available: www.acmhn.org/images/stories/Credentialing/ acmhn-postgrad-report-final.pdf Evangelou, M. (2010). Student experiences of the undergraduate nursing degree. IJMHN, 19, 369–370. Happell, B.,Moxham, L., & Clark, K (2011). Implementation of a major in mental health nursing in Australian universities. IJMHN, 20(4),237-246. Happell, B. (2014). Let the buyer beware! Loss of professional identity in mental health nursing. IJMHN, 23(2),99-100. Health Workforce Australia (2013). Mental health workforce study. Available: www.hwa. gov.au/sites/uploads/HWA-Mental-Health-Workforce-Data-Inventory_LR.pdf Hurley, J., Hanson, S., & Morgan, M. (2012). A regional case study of resurrecting mental health within undergraduate nursing education. In R. Vanderzwan (Ed.), Current Trends in Technology and Society, Volume 1. (p. 96-103), Brisbane: Primrose Hall Publishing Group. Hurley, J., Rowe, S., Linsley, P., & Fontenella, F. Empathy at a distance: A qualitative study on the impact of publically displayed art on observers. Accepted March, 2014, IJMHN. Warelow, P. & Edward, K. (2009). Australian nursing curricula and mental health recruitment. International Journal of Nursing Practice, 15(4), 250–256.
John Hurley is an Associate Professor of Nursing at Coffs Harbour Professor Iain Graham is Head of School in Lismore Steve Van Vorst, MSc, MHN is a lecturer at Gold Coast University Professor Andrew Cashin, is a Professor of Nursing at Lismore
By Andrew Watkins In Australia people living with a mental illness experience much poorer physical health outcomes compared to the general population. West Australian data indicates that there is a life expectancy gap of in excess of 20 years for people experiencing some types of mental illness. Nearly four in every five of these premature deaths are associated with physical health conditions driven in the main by cardiovascular disease (Lawrence, Hancock, and Kisely 2013). There is a multitude of reasons for the poorer physical health encountered by people experiencing mental illness, contributing in part are very high smoking rates, poor diets and low levels of physical activity (Morgan et al. 2013). These issues can be substantially exacerbated by medications used to treat mental illness that cause marked weight gain and metabolic complications. Anti-psychotic medications in particular can cause very significant weight gain in a matter of weeks (Foley and Morley 2011).
“There is a multitude of reasons for the poorer physical health encountered by people experiencing mental illness, contributing in part are very high smoking rates, poor diets and low levels of physical activity.” The high risk of cardiovascular disease that is faced by people experiencing mental illness necessitates regular metabolic monitoring. Screening for metabolic health should include checking for hypertension, dyslipidemia and glucose intolerance as well as increases in weight and waist circumference. Any deterioration in metabolic health needs to be identified in a prompt manner so that assertive interventions can be swiftly applied. A number of interventions have been shown to prevent and reduce the metabolic problems that prevalently occur in people experiencing mental illness. The
Mental Health The Productive Ward in an over productive environment By Caroline Dyer philosophy of ‘don’t just screen, intervene’ needs to be applied for all people experiencing mental illness in regards to their physical health care. Firstly, judicious use of psychiatric medications is extremely important, using them only where required at the lowest possible doses. Lifestyle interventions with diet and exercise have been shown to be effective, as has the use of metformin (Curtis, Newall, and Samaras 2012). An algorithm guide for clinicians on the management of metabolic complications is available at: www.iphys.org.au Addressing metabolic health issues requires strong leadership from nurses. As a profession we are ideally positioned to take up this role. Nurses can change the current disconnect between the body and the mind that has been prevalent in mental health services through screening of metabolic health, promotion of a healthy lifestyle and advocacy of good prescribing habits. This approach will provide a more holistic model of care for mental health that ‘keeps the body in mind’.
Curtis, J., Newall, H.D. and Samaras, K., (2012). The heart of the matter: cardiometabolic care in youth with psychosis. Early Intervention in Psychiatry 6 (3):347-53. Foley, D. L. and Morley, K.I.,(2011). Systematic review of early cardiometabolic outcomes of the first treated episode of psychosis. Archives of General Psychiatry 68 (6):609-616. Lawrence, D., Hancock, K.J. and Stephen Kisely., (2013). The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ: British Medical Journal 346. Morgan, VA, JJ McGrath, A Jablensky, JC Badcock, A Waterreus, R Bush, V Carr, D Castle, M Cohen, and C Galletly., (2013). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological medicine:1-14.
Andrew Watkins is a clinical nurse consultant and coordinator of Keeping the Body in Mind Program at the Bondi Centre, SESLHD in Sydney
Our mental health inpatient unit has recently commenced implementing the ‘Productive Ward’ which is a toolkit designed to help release time to care. There are four key objectives: to improve patient safety and reliability of care, improve patient experience, improve staff wellbeing and to improve efficacy of care. The introduction of this concept was met with scepticism that was equal in volume to the enthusiasm and motivation I felt. “Aren’t we already productive enough in our very busy acute mental health ward? How can we possibly find time to be even more productive”, were common cries of desperation coming from the staff. We needed a ‘Vision’, we needed to ‘Know How We Are Doing’ and we hoped to have a ‘Well Organised Ward’ (WOW) all of which are the foundation modules in the toolkit. We commenced an activity called ‘Follow’ which records the time in minutes nursing staff spent in direct care time with the patients, It was a very stark reality check that found we spend less than 50% of the shift in direct patient care.
“We conduct waste walks and use spaghetti diagrams to see how much time is spent walking from one place to another when there is a far quicker alternative such as moving the linen to an area that is easily accessible and reducing the amount of “steps” taken to refer a patient to the community clinic.” So what were we doing for the other 50% of the time? Searching is one example, such as looking for patients, equipment, files and property. If on average each staff member spent 15 minutes per shift searching for stock in the storeroom and treatment room per day, that’s four hours per day or 28 hours per week, the equivalent to over 0.5 FTE.
We needed to WOW our ward. Our storeroom and treatment room were first to be hit. For years we had been demanding more shelving, cupboards and storage room, when in actual fact we realised once we had cleared out the expired stock Florence Nightingale had ordered and re-evaluated what supplies we did in fact need, we had empty shelving. And despite media reports, there isn’t an imminent nuclear holocaust that is cause for stockpiling enough plastic cups and insulin syringes to see us into the year 2100. We followed the 5S process to sort, set, shine, standardise and sustain the area. The Productive Ward is an ongoing process. We continue to audit medication errors, aggressive incidences, unplanned leave/absenteeism and episodes of selfharm using the Safety Cross tool. We conduct waste walks and use spaghetti diagrams to see how much time is spent walking from one place to another when there is a far quicker alternative such as moving the linen to an area that is easily accessible and reducing the amount of “steps” taken to refer a patient to the community clinic. Our storeroom and treatment rooms are labelled and there is a defined place for everything. Order is being restored, waste is being reduced and our direct patient contact time is increasing. With another nine modules still to complete, this is only the beginning. Watch this space! The Productive Mental Health Ward – Toolkit is published by the NHS Institute for Innovation and Improvement, Coventry House, University of Warwick Campus, Coventry, CV4 7AL. For more information: www.institute.nhs.uk/productivementalhealthward Caroline Dyer is an A/Clinical Nurse Specialist at the Armadale Mental Health Service – adult acute ward in WA
PAGE 45 June 2014 Volume 21, No. 11.
M y Ne w Car Wi sh List Ne w f amily car (red please!) T h e v ery best d eal on price & no GST t o pay! M y choice of fu el card s. I n su rance, warranty & roadsi de assi st ance. DVD player for the k id s ( i n t h e b a c k s e a t ! )
W h o ca n t ick all of these boxe s? Smartleasing can. With over 10 years experience, 30,000 leases under management and local representatives in every state, weâ€™re sure to find the perfect deal for you! Call us today to find out more.
1300 176 168 | www.nurseleasing.com.au DISCLAIMER: Smartsalary cannot provide taxation or financial advice, we strongly encourage you to seek financial advice prior to entering into any lease arrangements. For full terms and conditions please visit our website.
MedicAlert medical IDs come in a range of colours and styles... ÂŽ
...and all serve the same important purpose. Vital information can be communicated in a medical emergency. Remember to check your patients around the wrist and neck for the genuine MedicAlert medical ID. www.medicalert.org.au
Mental Health The alcohol smoking and substance involvement screening test in an acute mental health setting By Karen Heslop and Calum Ross The number of patients admitted to acute mental health facilities with identified co-occurring drug and alcohol issues is increasing, representing 40% of all inpatient admissions to acute mental health facilities in WA. This requires mental health nurses to have expert skills in assessing and providing interventions for individuals with mental illness and co-occurring alcohol and substance issues. The National Practice Standards for the Mental Health Workforce (2013) require that all mental health workers in Australia not only understand the specific needs of individuals with mental health problems and co-occurring alcohol and substance use/abuse, but facilitate or conduct appropriate screening and assessment (Safety and Quality Partnership Standing Committee, 2013). The World Health Organization’s (WHO) ‘Alcohol Smoking and Substance Involvement Screening Test’ (ASSIST) is a brief easily administered, valid and reliable screening instrument which highlights the use of psycho-active substances in individuals. It is able to discriminate between substance use, abuse and dependence. Although the ASSIST was initially designed for use in the primary health care setting, it is easily adapted for use in the acute mental health setting. Objectives: To determine whether the introduction of the ASSIST and an in-vivo education program improved health outcomes for patients with a mental illness and co-occurring drug and alcohol issues. Method: As part of a ‘before and after intervention’ study, a one page version of the ASSIST and associated brief interventions were implemented following an in-vivo education program run at an acute mental health unit attached to a tertiary hospital in WA.
Outcomes: Significant improvements were demonstrated in nurse’s knowledge and confidence (as measured by the ‘nurses’ knowledge, attitudes and beliefs regarding substance use’ questionnaire (Happell, Carta & Pinikahana, 2002) in the areas of assessment, identification and management of drug and alcohol issues, providing information about drugs and alcohol and referral or information on appropriate support services. A review of patient medical records post intervention and six months later demonstrated translation of acquired knowledge into patient care. Implications for Mental Health Nursing: Improving mental health nurses knowledge and confidence in relation to the assessment and management of patients with a mental illness and co-occurring drug and alcohol issues resulted in improvements in the delivery of appropriate optimal health care to these individuals.
References Happell, B., Carta, B., & Pinikahana, J., (2002). Nurses’ knowledge, attitudes and beliefs regarding substance use: a questionnaire survey. Nursing & Health Sciences, 4(4), 193-200. Safety and Quality Partnership Standing Committee., (2013). National practice standards for the mental health workforce 2013. (1310001). Melbourne, Victoria: Victorian Government Department of Health. Karen Heslop is a clinical nurse consultant, Practice Improvement (Mental Health) and Calum Ross is a clinical nurse specialist – Drug and Alcohol Service. Both are located in the Department of Psychiatry at the Royal Perth Hospital in WA
Improving continence management of long stay mental health populations By Winifred Leigh Boivin Between 2009 and 2012 a multidisciplinary project group worked to improve continence management within a metropolitan mental health hospital. Mental health units favour a pleasing visual aesthetic as a therapeutic tool to encourage feelings of wellbeing, including use of difficult to clean carpets and fabric covered seating. A small but significant percentage of patients suffer from incontinence, and incontinence accidents have contaminated carpets and fabric covered chairs in communal living areas. Urgent thorough cleaning is important, but the cleaning processes can be slow, particularly out of environmental service business hours.
Staff surveyed 175 patients (134 (68%) male, 62 (32%) female) to identify continence patterns, defining incontinence as ‘urine or faeces excreted outside the toilet, or would have been without staff intervention’. Of the sample 45 (25.7%) patients (23 (51%) male, 22 (49%) female) were found to have some incontinence. Fifteen (33%) had incontinence episodes once per week or more, and 15 (33%) had incontinence episodes more than once every 24 hours. Physical health records were checked for evidence of continence assessment, visits to urology clinics, continence clinics, or other specialist services. Only one patient had attended a continence clinic. Of the 175 surveyed patients, 91 (52%) were prescribed Clozapine, but only 24 (26%) were in the incontinent group, consistent with the general incontinence rate. Forty four percent of the incontinent group (10 male, 10 female) were diabetic.
PAGE 47 June 2014 Volume 21, No. 11.
20-29 30-39 40-49 50-59
Focus 60-69 70-79 80-89 0
Youth to benefit from Fiona Stanley Hospital mental health service
Incontinent Females 10-19
Incontinent Females Incontinent Males
Continent Patients 50
50-59 20 60-69 10
Fiona Stanley Hospital’s mental health service in Murdoch, Western Australia 0
Number of patients
Continence management chart
Following the survey, 22 patients were assessed at the local continence clinics, and recommendations implemented. Night toileting was shown to be an ineffective way of preventing incontinence. The use of pads and kylies increased to reduce night toileting. Easy clean floor vinyl has been installed in many areas, and this is ongoing as budget allows. Where new carpets are laid, carpet tiles are installed to allow easy replacement. All chairs in patient areas were replaced with waterproof easy clean vinyls. An after-hours carpet cleaning protocol has been developed, and a small cleaner purchased for rapid spot cleaning. A staff education campaign to improve understanding of incontinence included newsletter articles, and circulation of ‘Continence Foundation of Australia’ pamphlets and DVDs. It is intended to repeat the continence ‘snap shot’ and review of interventions every five years to continue to improve our continence management.
• Improved dignity and increased sleep for incontinent patients through access to specialist services, and their assistance with developing good management strategies and optimising use of continence aids, and • A cleaner environment with reduced infection risks. Winifred Leigh Boivin is an infection prevention & control clinical nurse specialist, mental health drug & alcohol at Macquarie Hospital in NSW PAGE 48
By Lucy Kirwan-Ward
Years of Age
Opening in February next year, Fiona Stanley Hospital’s (FSH) purpose-built mental health service will consist of 30 beds, including an eight-bed mother and baby unit. The mental health service will provide assessment and treatment for patients with complex mental health disorders who require a high level of care for a short period of time. The mental health service will also cater specifically to youth, which is a first in Western Australia. FSH Co-Director Paula Chatfield said for the first time, a dedicated service would provide specialised inpatient care for young people aged between 16 and 24. “A need to provide individualised treatment for this vulnerable cohort has long been recognised by the mental health field. This age group is at a challenging stage of life, confronted with a whole range of life experiences, and this is when many mental health disorders begin to emerge. They require different types of care.” FSH’s dedicated youth unit – YoU – will provide care for a range of diagnostic groups in a supportive environment designed specifically for young people. It will be staffed by clinicians that have been specially trained in evidence-based, best practice interventions and age-appropriate therapies. “Having specialist skills and a solid understanding of the developmental journey of
young people will allow for early intervention and more positive outcomes, not only for the young people, but also for their families and the community, which are also impacted by mental health disorders,” Ms Chatfield said. FSH worked closely with community based youth services to develop the new service, which will involve strong collaboration between a wide range of health providers to build and strengthen support for young people with mental health disorders in the community. “It will give young people access to a level of care they haven’t been able to receive before and help prevent them getting lost in a system, which up until now, has focused on youths up to the age of 18, and adults,” Ms Chatfield said. “Everyone involved should be extremely proud of their input into developing a multidisciplinary service that will help get young people back on track sooner.” FSH will rank among the best hospitals in Australia and will be a leader in clinical care, research and education. It will offer comprehensive health care services to communities south of Perth and across the state. More information on FSH and career opportunities can be found at: www.fsh. health.wa.gov.au Lucy Kirwan-Ward is a senior engagement & communications officer at Fiona Stanley Hospital in WA
Mental Health Hospitality in mental health nursing By Eimear Muir-Cochrane The experience of psychiatric inpatient hospitalisation has received increasing scrutiny over recent years. Risk to self or others is usually the core reason for admission to hospital, and as such nurses are required to maintain safety for patients. However, patients have mixed feelings about their hospitalisation which is often negative. The trauma experienced has been termed ‘sanctuary harm’ to recognise the impact of the experience. Thus, it is important to provide a therapeutic milieu for service users to improve their recovery and experience of hospitalisation. Hospitality is an ancient concept and one that provides cohesion in societies in every culture. The word hospitality derives from the Latin ‘hospes’ and refers to host and guest or stranger. Hospitality involves showing respect for one’s guests (strangers), providing for their needs, and treating them
as equals. Hospitality is at the core of human connection, empathy and genuineness. The role of the host is to protect and provide for the guest, and create an environment that is empathic and nurturing. I contend that this is a powerful and therapeutic way for clinicians to view and engage with patients - as guests who are not familiar to them and who are likely to experience strangeness in the environment around them and those within it. To extend this concept then, the illness and symptoms of the patient are also strange to the nurse and their role is to become familiar with the phenomenon of illness from the patient’s perspective. This is highly skilled work requiring genuine concern and engagement with people in mental distress. Importantly, I am not suggesting that nurses behave as if they are exchanging goods and services such as in the hotel or food industry. Not at all, I am proposing that nurses in all settings (not just mental health) can be fabulous hosts to patients and their significant others, creating a sense of care and kindness that can facilitate personal engagement and a positive hospitalisation
Professor Eimear Muir-Cochrane
experience. A well-known fast food chain has a three metre rule… if a worker is within three metres of a customer, they greet them in a friendly and smiling manner. I challenge all of us to do this in our everyday work in all workplaces. I look forward to your comments about this. Professor Eimear Muir-Cochrane is Chair of Nursing (Mental Health) at Flinders University
Open borders By Sheila Mortimer-Jones Borderline personality disorder is characterised by emotional instability, intense and unstable relationships and fear of abandonment. People with this disorder frequently present in crisis to emergency departments following an episode of self-harm or suicide attempt, which often results in hospital admission. To address this Hampton Road Service, a public, state-wide residential facility for mental health consumers in Western Australia, commenced their Open Borders program. This is an innovative project that offers those diagnosed with borderline personality disorder an alternative to hospitalisation by allowing them to arrange their own admission, rather than going through the usual channels. The theory of this program is that self-harm behaviours will be less frequent if consumers can access immediate support. The aim is to improve
mental health while greatly reducing the cost to the health service. Dr Sheila Mortimer-Jones, a registered mental health nurse and lecturer at the School of Health Professions, Murdoch University, will study the efficacy of the program in collaboration with South Metropolitan Health Service. This research will explore whether the Open Borders program is an effective alternative to general psychiatric treatment by a process of assessment and data collection over two years; comparing social functioning and the number of presentations and hospital admissions with a comparable group of consumers who are not in the program. If this study shows that the program is successful it could become a model for the treatment of this group of consumers and have important implications for practice nationwide, freeing up some of the inpatient beds that are constantly in such short supply. This project therefore has national significance and may have demonstrable application for health policy and services.
consultant psychiatrist at ArmadaleKelmscott Memorial Hospital and Clinical Associate Professor in Psychiatry at the University of Western Australia; Professor Paul Morrison, Dean of Health Professions, Murdoch University; Professor Dianne Wynaden, School of Nursing and Midwifery, Curtin University and Ms Amanda Bostwick, Coordinator of Hampton Road Service, Fremantle Hospital. Dr Sheila Mortimer-Jones is located in the School of Health Professions at Murdoch University in WA L-R Sheila Mortimer-Jones and Amanda Bostwick
Dr Mortimer-Jones is leading the research team that includes Dr Ahmed Munib, PAGE 49 June 2014 Volume 21, No. 11.
Focus A specialist nurse role improves Nurse professionals the physical health behaviours viable in mental of mental health consumers nurse, and initial assessments confirmed their poor physical health and health behaviours including low levels of physical activity, poor diet and the high prevalence of smoking.
By Robert Stanton and Brenda Happell Integration of physical and mental health services may be a practical and cost-effective strategy to address the poor physical health of mental health consumers. In many respects, nurses working in mental health are ideally placed to address this physical health care gap. However, their work in this space is often hampered by lack of time, lack of resources or policy constraints. A recent study, led by Professor Brenda Happell from CQUniversity, addressed this service gap by trialing a specialist cardiometabolic health nurse at a mental health service in regional Queensland. The goal of the cardiometabolic health nurse was to coordinate the physical health care of community mental health consumers by identifying the need for, and providing referrals to, additional services including primary care and community-based services. Twenty one consumers were referred to the cardiometabolic health nurse by their case managers or mental health PAGE 50
The cardiometabolic health nurse referred 13 consumers for additional physical health care services, predominately to a General Practitioner for routine blood tests. She also provided individualised physical activity and nutritional advice for almost three quarters of participants. Following the trial consumers showed on average an increase in physical activity, consumption of fruits and vegetables increased by an average of half a serve per day, and some consumers ceased smoking as a result of the nurse-led intervention. These results, although modest, highlight the potential of the cardiometabolic health nurse to improve the physical health behaviours of people with mental illness. They also highlight the need of a cardiometabolic health nurse to have a comprehensive understanding of physical health behaviour change. This is particularly important when it comes to physical activity and nutrition, since many consumers may be unable to attend consultations where out-of-pocket expenses are incurred. Given these initial encouraging results, Professor Happell and her team are developing a larger, multi-site trial. Studies such as these may help inform policy and practice, and eventually transform the physical health care of mental health consumers. Robert Stanton and Professor Brenda Happell work at the Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University
health care By Stephanie Hille
Nurses are a substantial component of the primary health care workforce, and make an increasingly important contribution to primary health care in Australia. Primary health care nurses play a major role in improving health outcomes through their role in delivering quality chronic disease management, preventative care as well as curative care, care for the ageing, dealing with issues such as medicine safety, and implementing improvements in primary health care systems. Nurses in primary health care are accessible and approachable to patients, and it is through these interstitial interactions nurses are able to recognise the signs or elicit concerns associated with issues of mental health. Primary health care nurses are proven to deliver cost effective and clinically effective care, particularly in the areas of chronic disease management, screening, prevention and population health. A widespread failure to understand the capacity of nurses working in primary health care means nurses are not being utilised as well or extensively as the nurse scope allows. Despite being the largest health practitioner workforce in Australia with 350,000 registered nurses, many of whom work in the primary care sector, nurses are often overlooked when it comes to structures and programs to support nurse delivery of care. Systems are developed that impede nurses from applying all of their skills in what is a very broad scope of practice. Beyond the base scope of a nurse working in primary health care in Australia are specialised roles such as general practice nurses, mental health nurses and nurse practitioners, all of whom play their role in patient care for those impacted by mental health concerns and illness.
Mental Health CQUniversity leads innovation in mental health nursing By Brenda Happell, Louise Byrne, Chris Platania-Phung, Scott Harris and Julie Bradshaw However, nurse practitioners have limited access to funding in primary health care including items on the Medicare Benefits Schedule (MBS), and for activities that attract a rebate the sum is inadequate, while general practice nurses cannot access MBS items at all. Nurse practitioners have a
“A widespread failure to understand the capacity of nurses working in primary health care means nurses are not being utilised as well or extensively as the nurse scope allows.” huge potential to benefit primary health care and this needs to be explored with investment in the role and improved funding mechanisms. With appropriate training at undergraduate level and beyond, this workforce is a highly cost effective and clinically effective provider of care within primary health care services and programs. Australian Primary Health Care Association (APNA) supports the following to facilitate the capacity of nurses in mental health care: • increased mental health content at undergraduate level, and quality mental health clinical placements. • access to quality continuing professional development on mental health care for all registered nurses, with an emphasis on nurses working in primary health care. • making the business case for nurse practitioners in mental health viable. • incentivise collaborative arrangements and pathways for referrals between primary health care clinicians working in general practice and mental health nurses. Stephanie Hille is the Communications and Policy Coordinator at APNA
Recovery-focused mental health services has certainly become the language of the day. Most mental health services acknowledge there is some way to go before this becomes a reality. Achieving recovery-focused services is dependent on genuine partnership with people with lived experience of significant mental health challenges. This is easier said than done. Challenging the traditional ‘clinician knows best’ attitude is imperative. As the largest professional group in the mental health nursing workforce nurses are key if recovery-focused services are to become a reality. Achieving this requires a conceptually different approach to the education of nursing students. Now employing two academic staff with lived experience and providing the research evidence to support this initiative, CQUniversity is proudly leading this important educational reform. Our research findings have given us confidence that this approach will reduce the negative stereotypes students have about mental illness, and produce more compassionate, person-centered registered nurses. One very welcome finding is that lived experience involvement may make mental health nursing more popular. Comparing two groups of students, the group who com-
“Now employing two academic staff with lived experience and providing the research evidence to support this initiative, CQUniversity is proudly leading this important educational reform.” pleted the lived-experience led recovery and the other completing the traditional nurse-led mental health nursing subject, showed a significantly higher interest in mental health nursing as a career at the end of the subject, while no similar change was observed from the students in the more traditional subject.
Louise Byrne, lived experience academic
These findings were welcomed by the research team from the Centre for Mental Health Nursing Innovation (CMHNI), comprising Louise Byrne, Brenda Happell, Chris Platania-Phung, Scott Harris and Julie Bradshaw. The unpopularity of mental health nursing compared to most other areas of clinical specialty is well documented in the literature. Strategies to address the problem are unfortunately scarce. Including lived experience in the education of health professionals has been a national policy expectation since the release of the National Practice Standards for the Mental Health Workforce in 2002, and is acknowledged as crucial for recovery-focused services. Yet research has consistently shown this involvement is minimal and often tokenistic. While more research is needed, CMHNI is committed to advancing this important contribution to the evidence-base for the value and necessity of lived experience led education for the preparation of recoveryfocused health professionals and in encouraging nursing students to appreciate the value of mental health nursing as a career. Professor Brenda Happell, Louise Byrne, Dr Chris Platania-Phung, Scott Harris and Julie Bradshaw are from the Central Queensland University, Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery
PAGE 51 June 2014 Volume 21, No. 11.
Anti-Poverty Week focuses on poverty around the world, including Australia. It includes the UN’s International Anti-Poverty Day, 17 October. The Week’s main aims are to: • strengthen public understanding of the causes and consequences of poverty and hardship; • encourage research, discussion and action to address these problems. The website www.antipovertyweek.org.au includes basic fact sheets, promotional material, a calendar of activities and links to other sources of information and ideas. It also includes contact details for the National Office and the Co-Chairs in each State.
For more info or to list activities on the website, contact us at 1300-797-290 or email@example.com
Stay updated with the latest from the ANMF by visiting our website and following us on social media.
Visit our website at www.anmf.org.au Like us on Facebook at www.facebook.com/ AustralianNursingand MidwiferyFederation
Follow us on Twitter at @anmfbetterhands
FIFO, FIFO... It’s off to Wagga we go. We currently have a number of Fly-In Fly-Out opportunities for Registered Nurses to join our multidisciplinary team in Wagga Wagga, NSW, on 12 month contracts providing on-base healthcare to the Australian Defence Force (ADF). You’ll be provided with all flights, accommodation and a generous meal allowance. To be credentialed with us as a RN you must meet our Minimum Credentialing Criteria (MCC). For more information, scan the QR code with a free smartphone app, call our Recruitment team on 02 6203 9224 or email firstname.lastname@example.org.
Books The Back Pain Personal Health Plan Bounce back edition
By Nick Sinfield and Trish RRP: $29.99 Wisbey-Roth Publisher: Exisle Publishing ISBN: 978-0-9568837-2-8
It is no fun having a bad back, as many nurses can attest to. Around eight out of ten Australians will experience back pain at some time in their lives. For those who have tried a number of treatments and failed to find a lasting solution, the condition can have a devastating impact on the quality of their lives. The Back Pain Personal Health Plan – bounce back edition aims to help sufferers take control of their pain management. The comprehensive self-help
manual is written by two physiotherapists who have extensive experience in the area of back pain. The highly illustrated book covers how to break fear and anxiety cycle that keeps them in a vulnerable and painful state. It also demonstrates ways to improve posture, ease muscle tightness, strengthen back muscles and increase confidence through exercise.
Art and Chronic Pain - A self portrait By Soula Mantalvanos RRP: $39 Self-published ISBN: 9780992381400 www.pudendalnerve.com.au
Art and Chronic Pain – A self portrait is one woman’s journey as she learns to live with a chronic pain condition. Soula’s story began after sitting on a fit ball that burst leaving her with a pelvic chronic pain condition that she has had to manage and come to terms with. Beautifully illustrated by Soula herself, the books details her thoughts and feelings about pain as she lives through her journey. Others experi-
encing chronic pain may find comfort in this book relating to Soula’s experiences.
The Nerdy Nurse’s Guide to Technology By Brittney Wilson RRP: US $34.95 Publisher: Sigma Theta Tau International ISBN: 9781937554385
As technology continues to evolve in the health care arena, nurses and midwives are increasingly required to utilise different applications to enhance practice. The author, a renowned blogger, technology guru and clinical informatics specialist, provides the reader with practical application tools they need to embrace technology and be successful. Written with humour, the book also provides tools nurses need to improve their practices, further their careers and
solidify themselves as assets to their employers. The book details everything from social media, smartphones, computers and tablets to electronic documentation. Additionally, there is advice on how technology can heighten career advancement.
By Karolyn Crowley and Carrie Morgan RRP: US $34.95 Publisher: Sigma Theta Tau International ISBN: 9781938835155
Recovering from drug and/or alcohol can be a long and turbulent journey. While approximately one in 10 nurses may be impaired by or are in recovery from alcohol or drug addiction, nurses who seek treatment have a good chance of successful recovery.
re-entry and also a guide for supervisors, colleagues and administrators. The book is full of real-world, down-to-earth advice with many tried and true techniques for the road to recovery.
This book assists nurses trying to regain control of their lives and careers. The guide, which is written by two renowned recovery facilitators, is a personal compass for nurses travelling from addiction to professional
Written in a conversational style mixed with humour and hope, the authors help the reader to address issues such as shame and loss of professional standing, triggers and workplace stressors. PAGE 53 June 2014 Volume 21, No. 11.
wellbeing of individuals, local communities and populations. http://www.nursing-conf.org/
Emergency Nursing - the door that never closes 7-15 June, Pacific Island Cruise, Carnival Spirit, departs Sydney CPD Educational Cruises provide the most up to date clinically focused emergency nursing education. Presentations will be varied and include lectures, hypotheticals and case presentations. Topics will include current trends in emergency nursing with a city to rural perspective. Your presenter will also provide a session devoted to problems you experience in your ED and potential remedies. This is your opportunity to share knowledge and conundrums with your peers in an environment mixed with relaxation and fun. This conference offers 14 hours of continued professional education. http://cpdcruises.com. au/conferences/Emergency-Nursing-the-frontdoor-that-never-closes/ Lung Health Promotion Centre at The Alfred 11–12 June, Respiratory Course (Module B) 13 June, Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 18 June, Asthma Management Update 19-20 June, Spirometry Principles & Practice 25 June, Paediatric Respiratory Update Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: email@example.com Nurses-Healing Workshops 13-21 June, Glenelg SA. Boutique Training in Luxury Surroundings. These quality one day (6 hours CPD) workshops on massage, health and wellbeing give you the skills, knowledge and confidence to help clients with your hands, and health inspired presence. Calendar and information go to http://nurses-healing.com or contact Angeline von Doussa 0431 994 618 Email firstname.lastname@example.org Drug and Alcohol Nurses of Australasia (DANA) Conference Speak Up 18–20 June 2014 at the Mercure Sydney, NSW. www.danaconference.com.au APNA Continuing Education Workshops for Nurses in General Practice 20-21 June, Stamford Plaza, Adelaide, SA. For more information and to register go to www.apna.asn.au/nigp 2nd Annual Worldwide Nursing Conference Health Disparities 23-24 June, Singapore. Nursing practice is both a science and an art. It requires scientific skill yet demands a strong background in the social sciences and humanities. Nursing makes a significant contribution to the health maintenance, health promotion and
JULY Lung Health Promotion Centre at The Alfred 15 July, Educating & Presenting With Confidence 16-18 July, Asthma Educator’s Course 24-25 July, Smoking Cessation Facilitator’s Course 30–31 July, Creative Behaviour Change Coaching For Chronic Illness Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: email@example.com AIDS2014 Conference - Nursing Welcome Reception 19 July, 5-7:30pm, Crown Casino, Southbank Melbourne. Cost: FREE. All nurses and their colleagues are invited to the reception, being held at the commencement of the AIDS2014 Conference. Please join ASHM, ASHHNA, ANZANAC and the American Association for Nurses in AIDS Care (ANAC) to welcome our international nursing colleagues and celebrate the important work of nurses in HIV globally. The theme of the evening will be Nurses Stepping Up, Stepping Forward and Stepping Beyond, and there will be keynote presentations from Australian and international nursing leaders in HIV. You do not have to be a conference delegate to attend and it is a free event. Contact Emily Wheeler (Manager - ASHM Nursing Program) Email: emily. firstname.lastname@example.org or call (03) 9341 5244 or visit http://www.nursesinaidscare.org/i4a/forms/ index.cfm?id=150 Cancer Nurses Society of Australia 17th Annual Winter Congress Cancer Nursing: Leading in a time of change 24-26 July, Pullman Albert Park, Melbourne. http://cnsa.org.au/professional-development/ national-conferences.html APNA Continuing Education Workshops for Nurses in General Practice 25-26 July, Mercure Hotel Brisbane, QLD. For more information and to register go to www. apna.asn.au/nigp
Update’ study day with Kathy Mills, RN, MEd, Credentialled Diabetes Educator This study day for enrolled and registered nurses covers contemporary and evidence based research on dietary, exercise, psychological and pharmacological management of diabetes mellitus. Date: Friday August 8 from 9am-4pm at Inner East Melbourne Medicare Local, 6 Lakeside Drive, Burwood East. There is free onsite parking. Morning tea, lunch and notes are provided. Eligible for 6 hours professional education.
Cost: Early bird special (pay by Friday 25 July) is $220. Full registration fee: $250 All queries to Kathy via email only at diabetes. email@example.com Nursing Informatics Australia Conference E-health is changing healthcare: Nurses meeting the challenge. Smart phones, smart tablets, smart nurses. 11 August 2014, Melbourne Convention & Exhibition Centre. http://www.hisa.org.au/page/hic2014nia APNA Continuing Education for Nurses in General Practice 15–16 August, Novotel Canberra, ACT. For more information and to register go to www.apna.asn.au/nigp Lung Health Promotion Centre at The Alfred 18-19 August, Spirometry Principles & Practice Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: firstname.lastname@example.org 8th International Council of Nurses, International Nurse Practitioner/Advanced Practice Nursing Network Conference Advanced nursing practice: Expanding access and improving health care outcomes 18-20 August, Helsinki, Finland. http://www. nurses.fi/8th-icn-international-nurse-prac/ National Forum on Long Term Unemployment Building Capability 18-19 August, QT Hotel, Gold Coast Qld. This conference will address the causes of long term unemployment and what can be done for these at risk groups of disability, mature age, youth, indigenous and the regional unemployed. It will focus on Building Capability to successfully tackle long term unemployment and how to create employment for the future. http://longtermunemployment.org.au
Lung Health Promotion Centre at The Alfred 3–5 September / 15 – 16 October, Respiratory Course 3–5 September, Respiratory Course (Module A) Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: email@example.com CATSINaM 16th National Conference Embrace the difference within our people 23-25 September, Perth WA. http://catsin.org.au/
Network Royal Melbourne Hospital PTS School of 16 June 1964, 50-year reunion
Northern District School of Nursing School 103 1984 – 198, 30-year reunion
Contact Jenny Cunningham Email: jennifermonaghan@ bigpond.com.au
23 August, Bendigo. At a venue to be announced. Contact julesbarbetti@live. com.au or facebook
John Fawkner Private Hospital/Sacred Heart Hospital celebrates its 75th anniversary October. We are seeking memorabilia, old photographs, uniforms, books,
instruments, stories etc. from past staff, doctors and students. An open day and other activities are planned for this milestone event. Contact Chris Papas, Executive Secretary at chris.papas@health-
scope.com.au or Ph: (03) 9385 2501
Royal Adelaide Hospital Nurses Training, Group 895, 25-year reunion 29 November,
Adelaide. Contact Julia Curley Email: juliacurley@hotmail. com
Mail Letter of the month Caring about the unbefriended elderly
I am disgusted by the thought of a person dying in their own home to be found eight years after they had died, referred to in Professor Megan-Jane Johnstone’s article in April’s ANMJ. From my own experience befriending an elderly person can be quite gratifying. When I was a child we had an elderly woman living next door who had a disabled son living in a care facility and had little to no contact with the rest of her family. My mother and father assisted her with any household job such as the simple task of changing a light bulb. It was disappointing when she died that there were very few people who attended her funeral. In light of this I was proud to have been in her life and what my parents had done for her. When I became a teenager I became close to two elderly people who walked their dogs at the local park each morning. It always brightened my day speaking to them about their life and to see their faces light up when I met up with them. At one point the woman had a fall and the man had a stroke around the same time. When they returned to walking their dogs the other dog walkers walked the woman home and I walked the man home. I always had a good laugh with this man. When he died his daughter told me about how much he told them he enjoyed having my company and was surprised that a person my age would willingly spend so much time with him. I hadn’t realised the impact I had made for this man and will never forget him. Elderly citizens do require those around them to look out for them. It only takes one person to change how an elderly person lives the rest of their lives; especially when they still live in their own home independently. This should be a moral obligation everyone in the community should be responsible for. Nurses need to advocate for this to be a community action although it shouldn’t be purely left to nurses or other health care workers to initiate. Community is key and social networks a must for these people. Now in my early twenties and just beginning my career in nursing I have met patients who have lost contact with the outside world as some people put it and have depression due to this. I have heard stories that they have had an accident and it was a few days before someone came around to help them. Even if they are not my patient for a shift I still make the effort to go say hello to see how they are doing. I love to see them become happy from having my company even if it’s just a short time. I would like to think they have a better experience in hospital and make a difference to their life. Bianca Salter RN, Victoria
The winner of the ANMJ best letter receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email firstname.lastname@example.org Letters may be edited for clarity and space
Another perspective It has been a year now since I have finished my Initial Registration for Overseas Nurse (IRON) bridging program and yet most of my classmates are still jobless. It is very frustrating that even though most of us have the skills and experience as nurses, it is still very difficult to find employers who will offer sponsorship for our working visas. Apparently, the Australian government has tightened the rules which is understandable since the government only wants to prioritise the permanent residents and the citizens. But what I do not comprehend is the fact that Australia is still accepting applications from overseas nurses to do bridging programs. Why? If this is to fill in the demand for nurses, why make working visas difficult for us to have?
We have invested so much for this emotionally, psychologically and physically. Being away from home is already heartbreaking in addition to the fact that the money we have spent for the bridging programs are loans. We have come here as hopeful souls thinking we would be able to pursue our nursing career and dreams here in Australia and earn a decent amount which would supposedly pay our debts and support our families back home. But lately, this hope has become like a flicker of light slowly dying. Our journey to our dreams is turning to a disappointing, frustrating and heartbreaking road. I am keeping my fingers crossed that despite this current rough ride, we will still have what we have come here for. I am hoping. I am praying. Please hear. Please do.
Antibiotic overuse In response to ‘Action is needed against antibiotic resistance’ (April ANMJ). Many nurses including myself are extremely concerned and fully aware of the dire current and future consequences of antibiotic overuse and the resultant bacterial resistance in the general community as well as the health care setting. I work in an aged care facility where it is not uncommon at any given time to have five or six out of 60 residents on antibiotics. This can be for asymptomatic urinary abnormalities, a cough, head cold or suspected wound infection. Pathology is infrequently done prior to the commencement of antibiotics. This creates a risk to the resident themselves, other residents, all staff and the wider community. Are our aged care facilities becoming incubators for antibiotic resistant bacteria or are they just a reflection of the widespread overuse of antibiotics in the community? Is this happening in other aged care facilities? It would be enlightening and perhaps concerning to know. Helen Speirs, RN Victoria
Anonymous PAGE 55 June 2014 Volume 21, No. 11.
Sally Sally-Anne Jones, Federal Vice President
Putting theory into practice As we have recently celebrated International Nurses Day on 12 May, Florence Nightingale’s birthday, I had cause to reflect on nursing as a profession, its history and development. It is no mistake that nursing transitioned from being an apprentice based craft to a skilled, thinking profession, and that the transition was shaped by the work of nursing theorists – of which Florence Nightingale was the first. You may remember undertaking lectures or assignments on the nursing theorists and possibly wondered how they had relevance to nursing practice when as students, we were keen to embark on our careers, gain as many skills as we could and get our hands on patients! The development and study of nursing theories attempts to capture in research and literature the very essence of nursing, what makes our profession different, separate and unique in the context of multidisciplinary health settings. The nursing theories (and there are many to explore) can be profiled according to person (role or position of patient); environment (physical, psychological, social, spiritual); health (definition and meaning of) and nursing (what nursing means in the theory’s context). The theories approach health and nursing through many lenses - body systems, interpersonal relationships, behaviour, cultural safety, self-care, goal attainment, science of caring and many more. In the context of modern day practice, the way we nurse is most likely a blend of more than one theory as we adapt our nursing practice to our own work environment, our specialty, our experience, our patient/client type, our gender, our social background, personality, and education. Your own philosophy towards nursing shapes your practice. Everyone has one, whether you prefer a hands-on approach or a more theoretical approach, your personal nursing philosophy is defined by your values and beliefs. Exercises in clarifying your personal philosophy are really an opportunity to think about why you love nursing, what drew you to it, what does nursing do for you, what makes you feel bad about a shift that doesn’t go as you planned and what are some boundaries PAGE 56
you absolutely will not cross in carrying out your duties and responsibilities as a professional nurse. Patient safety may be one of those. When you consider your personal philosophy in conjunction with the nursing theories, you will find there are matches with some more than others. The theories are one way to express your professional nursing practice that is less about ‘touchy feely’ caring statements and more about what you are doing scientifically, methodologically in a profession that cares for others. I look to the theorists myself from time to time for inspiration and to connect to the history of the profession’s development as I seek to be a part of developing nursing’s future. It may be argued that the public are grateful for the instrumentalist ideology (aka medical model) that has formed the basis of nursing education as it produces nurses safe and competent in practical skills, who deliver care based on sound evidence, but we are professional nurses because there is more to quality patient care than the safe, adequate completion of tasks. My own personal nursing philosophy is this: I believe nursing is the name given to activities that go beyond providing clinical intervention or merely caring for someone. It is through shared moments that nurse and patient often unconsciously connect, loaded with cultural, historical, social, spiritual and psychological knowledge and experiences, and each person in that moment measures, shares, absorbs and reflects aspects of themselves to assist the other person in some way. The patient journey means a return to wellness or peaceful death; for me it is self-realisation, and sense of accomplishment. I feel the relationship between nurse and patient is reciprocal altruism, often unidentified, unacknowledged by either party, however each grows positively or negatively through that interaction, and is forever changed by it. I encourage you to explore the nursing theorists’ work and see how it translates into your current nursing practice.
Weâ€™ve been looking after the health industry for more than 15 years? Can you say that about your bank? Join the thousands of health employees who have made the switch.
13 63 73 option 3
visit a branch
Police Financial Services Limited ABN 33 087 651 661 AFSL 240293 (BankVic) 121 Cardigan Street Carlton Vic 3053. 4719bv 5.14 PAGE 57 June 2014 Volume 21, No. 11.
First State Super
Caring for the people who care
At First State Super we believe Australians who choose careers looking after others deserve to be confident that their super is in safe hands. Join the super fund that puts members first.
Call 1300 650 873 or visit firststatesuper.com.au Consider our product disclosure statement before making a decision about First State Super. Call us or visit our website for a copy. FSS Trustee Corporation ABN 11 118 202 672 ASFL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365.
ANMF Registered Office – Education and AJAN – Canberra Unit 3, 28 Eyre Street, Kingston ACT 2604 PO Box 4239, Kingston ACT 2604 T: (02) 6232 6533 | F: (02) 6232 6610 E: email@example.com | W: www.anmf.org.au
22/05/2014 9:31 am
ANMF Industrial, Professional and ANMJ – Melbourne Level 1, 365 Queen Street, Melbourne VIC 3000 T: (03) 9602 8500 | F: (03) 9602 8567 E: firstname.lastname@example.org | W: www.anmf.org.au
June 2014 issue of the Australian Nursing & Midwifery Journal